Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 32856 | CA |
NPI | 1003273962 |
---|---|
Provider Name | Michelle Longa |
First Address | Bakersfield, CA 93311-9516 |
Second Address | Milwaukie, OR 97222-4628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2016 |
Last Update Date | 24/01/2016 |