Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251X0800X | Physical Therapist - Orthopedic | 070018772 | IL |
N | 2251X0800X | Physical Therapist - Orthopedic | PT3900 | HI |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT42234 | CA |
NPI | 1053712612 |
---|---|
Provider Name | Ms. Lynette Ilagan Sanchez |
First Address | Chicago, IL 60625-5709 |
Second Address | San Diego, CA 92154 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2014 |
Last Update Date | 27/12/2021 |