Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 007240 | CA |
N | 2251H1200X | Hand | 007240 | CA |
N | 2251S0007X | Physical Therapist - Sports | 007240 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | 007240 | CA |
NPI | 1609947860 |
---|---|
Provider Name | Mr. Charles Gyden |
First Address | Inglewood, CA 90305-1030 |
Second Address | Inglewood, CA 90301-1110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 08/07/2007 |