Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 27436 | CA |
NPI | 1043723471 |
---|---|
Provider Name | Mrs. Shannon Dutter |
First Address | Santa Barbara, CA 93111-1731 |
Second Address | Santa Barbara, CA 93105-2662 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2017 |
Last Update Date | 07/11/2017 |