Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PT24994 | CA |
NPI | 1225461072 |
---|---|
Provider Name | Mr. Douglas Van Dusen |
First Address | Yuba City, CA 95991 |
Second Address | Yuba City, CA 95991-3652 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2013 |
Last Update Date | 03/10/2016 |