Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT 6917 | CA |
NPI | 1114176807 |
---|---|
Provider Name | Mrs. Carolou A Munson |
First Address | Yorba Linda, CA 92887-3430 |
Second Address | Yorba Linda, CA 92887-3430 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2008 |
Last Update Date | 17/09/2008 |