Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT 30414 | CA |
NPI | 1003010240 |
---|---|
Provider Name | Miss Jill M Werner |
First Address | Los Angeles, CA 90025-3158 |
Second Address | Los Angeles, CA 90033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2007 |
Last Update Date | 08/07/2007 |