Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 35048 | CA |
NPI | 1083852628 |
---|---|
Provider Name | Mrs. Emily Lynne Frevert |
First Address | Anaheim, CA 92807-3208 |
Second Address | Irvine, CA 92620-3670 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2009 |
Last Update Date | 03/02/2009 |