Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT25506 | CA |
NPI | 1063517191 |
---|---|
Provider Name | Ms. Vivian Gayle Eisenstadt |
First Address | Los Angeles, CA 90035-3320 |
Second Address | Los Angeles, CA 90035-3320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 08/07/2007 |