Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 13774 | CA |
NPI | 1376774174 |
---|---|
Provider Name | Ms. Judy Condie |
First Address | Carlsbad, CA 92008-3611 |
Second Address | Carlsbad, CA 92008-3611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2009 |
Last Update Date | 28/07/2009 |