Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 20358 | CA |
NPI | 1063641371 |
---|---|
Provider Name | Ms. Susan Hastings |
First Address | San Jose, CA 95128-4713 |
Second Address | San Jose, CA 95128-4713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2009 |
Last Update Date | 08/07/2009 |