Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003107335 |
---|---|
Provider Name | Michelle Thomas |
First Address | Pomona, CA 91766-4049 |
Second Address | Commerce, CA 90040-2449 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2011 |
Last Update Date | 20/04/2011 |