Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1033249297 |
---|---|
Provider Name | Mr. Greg Kammarmeyer |
First Address | Altadena, CA 91001-4529 |
Second Address | Altadena, CA 91001-4529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 08/07/2007 |