Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT22576 | CA |
N | 2251S0007X | Physical Therapist - Sports | PT22576 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT22576 | CA |
NPI | 1023298460 |
---|---|
Provider Name | Ms. Priscilla Park |
First Address | San Francisco, CA 94110-2077 |
Second Address | San Francisco, CA 94110-2077 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2007 |
Last Update Date | 20/08/2019 |