Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 29730 | CA |
Y | 2251P0200X | Physical Therapist - Pediatrics | 29730 | CA |
NPI | 1023334471 |
---|---|
Provider Name | Mrs. Janice A. Matthews |
First Address | Oakland, CA 94611-1207 |
Second Address | Oakland, CA 94611-4231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2010 |
Last Update Date | 09/04/2010 |