Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 20144 | CA |
NPI | 1285157909 |
---|---|
Provider Name | Ms. Kelley L Kubota |
First Address | Downey, CA 90242-3456 |
Second Address | Downey, CA 90242-3456 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2017 |
Last Update Date | 25/07/2017 |