Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT 34988 | CA |
N | 2251G0304X | Physical Therapist - Geriatrics | PT 34988 | CA |
NPI | 1083866495 |
---|---|
Provider Name | Mrs. Susan B Rabourn |
First Address | Carmel, CA 93922-2300 |
Second Address | Carmel, CA 93923-8650 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2008 |
Last Update Date | 16/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1062 | PHYSICAL THERAPIST LICENSE (01) | NC |
PT 34988 | PHYSICAL THERAPIST LICENSE (01) | CA |