Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | ||
N | 2251P0200X | Physical Therapist - Pediatrics |
NPI | 1003143041 |
---|---|
Provider Name | Ms. Clytic Marie Villas Tesorio |
First Address | Whittier, CA 90606 |
Second Address | Whittier, CA 90606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2009 |
Last Update Date | 12/11/2009 |