Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | A17-0927 | CO |
NPI | 1154091742 |
---|---|
Provider Name | Mr. Scott Lamb |
First Address | San Jose, CA 95138-1386 |
Second Address | Campbell, CA 95008-0614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2021 |
Last Update Date | 15/09/2021 |