Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 292743 | CA |
NPI | 1649899196 |
---|---|
Provider Name | Mrs. Elisabeth Alisa Brown |
First Address | Scotts Valley, CA 95066-4582 |
Second Address | Scotts Valley, CA 95066-4582 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2020 |
Last Update Date | 04/02/2022 |