Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225200000X | Physical Therapy Assistant | 2106715 | TX |
Y | 225200000X | Physical Therapy Assistant | 48421 | CA |
NPI | 1003281676 |
---|---|
Provider Name | Miss Lauren Renee Sobotik |
First Address | Houston, TX 77059-5512 |
Second Address | Hawthorne, CA 90250-3459 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2015 |
Last Update Date | 13/12/2016 |