Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 32937 | CA |
N | 225100000X | Physical Therapist | PT60080887 | WA |
NPI | 1003077959 |
---|---|
Provider Name | Mrs. Joanne Delosreyes Pho |
First Address | Fremont, CA 94538-3925 |
Second Address | San Jose, CA 95119-1103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2008 |
Last Update Date | 30/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000000 | NOT APPLICABLE (01) |