Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT9290 | CA |
NPI | 1003013251 |
---|---|
Provider Name | Ms. Peggy Sue Perock |
First Address | Sherman Oaks, CA 91403 |
Second Address | Los Angeles, CA 90036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 08/07/2007 |