Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT19841 | CA |
NPI | 1003003161 |
---|---|
Provider Name | Mr. Kenneth Randy Pinkerton |
First Address | Tustin, CA 92780-3108 |
Second Address | Tustin, CA 92780-3108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2007 |
Last Update Date | 08/12/2010 |