Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT 26851 | CA |
NPI | 1003175357 |
---|---|
Provider Name | Ms. Heather Hughes Rose |
First Address | Mountain View, CA 94043-3957 |
Second Address | Palo Alto, CA 94301-2302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2012 |
Last Update Date | 07/05/2012 |