Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 300562 | CA |
NPI | 1033884390 |
---|---|
Provider Name | Michelle Lam |
First Address | Lynwood, CA 90262-3533 |
Second Address | Lynwood, CA 90262-3533 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2021 |
Last Update Date | 10/08/2021 |