Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT8089 | CA |
NPI | 1043481161 |
---|---|
Provider Name | Mrs. Donna Mae Harue De Wit |
First Address | Westminster, CA 92683-1740 |
Second Address | Westminster, CA 92683-1740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2008 |
Last Update Date | 17/03/2008 |