Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT10947 | CA |
NPI | 1366727695 |
---|---|
Provider Name | Mr. Roger Hugh Rich |
First Address | Sherman Oaks, CA 91423-5701 |
Second Address | Sherman Oaks, CA 91423-5701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2011 |
Last Update Date | 18/10/2011 |