Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT6659 | CA |
N | 2251G0304X | Physical Therapist - Geriatrics | PT6659 | CA |
NPI | 1255367785 |
---|---|
Provider Name | Ms. Surinder P. Brar |
First Address | Aliso Viejo, CA 92656-5251 |
Second Address | Aliso Viejo, CA 92656-5251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2006 |
Last Update Date | 26/09/2018 |