Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2320 | CA |
NPI | 1023149770 |
---|---|
Provider Name | Mrs. Denise Favreau Shipley |
First Address | Templeton, CA 93465-3615 |
Second Address | Templeton, CA 93465-5603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 08/07/2007 |