Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 8320 | CA |
NPI | 1124297304 |
---|---|
Provider Name | Mrs. Joan Iris Jacobs |
First Address | Torrance, CA 90501-2800 |
Second Address | Torrance, CA 90501-2800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2008 |
Last Update Date | 21/02/2008 |