Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 13057 | CA |
NPI | 1619150760 |
---|---|
Provider Name | Ms. Herlene Lew Mclees |
First Address | Culver City, CA 90230-6609 |
Second Address | Culver City, CA 90230-6609 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2007 |
Last Update Date | 26/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AT461 | (02) | CA |