Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 42313 | CA |
NPI | 1093487258 |
---|---|
Provider Name | Mrs. Samantha Lynn Hale |
First Address | Mather, CA 95655-4116 |
Second Address | Mather, CA 95655-4116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2021 |
Last Update Date | 07/10/2021 |