Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 15842 | CA |
NPI | 1417944711 |
---|---|
Provider Name | Mrs. Alice Barron Kahl |
First Address | Newport Beach, CA 92660-2678 |
Second Address | Newport Beach, CA 92660-2678 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2005 |
Last Update Date | 04/08/2017 |