Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT28069 | CA |
NPI | 1467659607 |
---|---|
Provider Name | Mrs. Michelle Marie Brodie |
First Address | San Diego, CA 92116-2113 |
Second Address | San Diego, CA 92154-8404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 08/07/2007 |