Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT24937 | CA |
Y | 2251P0200X | Physical Therapist - Pediatrics |
NPI | 1003991522 |
---|---|
Provider Name | Ms. Lee B. Williams |
First Address | San Luis Obispo, CA 93401-6038 |
Second Address | San Luis Obispo, CA 93401-6038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 08/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
770548601 | (02) | CA |