Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | AT 4120 | CA |
NPI | 1013053040 |
---|---|
Provider Name | Mr. David Evan Shuey |
First Address | Redlands, CA 92374-5567 |
Second Address | San Jacinto, CA 92583 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 08/07/2007 |