Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA49006 | CA |
NPI | 1013423623 |
---|---|
Provider Name | Mr. Andy Luu |
First Address | Davis, CA 95618-6724 |
Second Address | Vacaville, CA 95687-3353 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2017 |
Last Update Date | 19/12/2017 |