Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT 14031 | CA |
N | 2251S0007X | Physical Therapist - Sports | PT 14031 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT14031 | CA |
NPI | 1457431009 |
---|---|
Provider Name | Mr. Michael Eliot Low |
First Address | Roseville, CA 95661-7354 |
Second Address | Sacramento, CA 95816-4743 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0PT140310 | BLUE SHIELD (01) | CA |