Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 37792 | CA |
NPI | 1346317732 |
---|---|
Provider Name | Ms. Nadine Joye Waeghe |
First Address | Redwood City, CA 94061-2124 |
Second Address | Redwood City, CA 94063-4117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 26/09/2011 |