Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 10286 | CA |
NPI | 1003273657 |
---|---|
Provider Name | Mr. Kevin Magsino |
First Address | Glendora, CA 91740-4545 |
Second Address | Glendora, CA 91740-4545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2016 |
Last Update Date | 26/01/2016 |