Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT21461 | CA |
N | 2251G0304X | Physical Therapist - Geriatrics | PT21461 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT21461 | CA |
NPI | 1265669592 |
---|---|
Provider Name | Ms. Sandra Rodriguez Harris |
First Address | Chula Vista, CA 91914-4150 |
Second Address | Chula Vista, CA 91914-4150 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2009 |
Last Update Date | 13/06/2009 |