Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT27434 | CA |
NPI | 1295853489 |
---|---|
Provider Name | Ndidiamaka Dillibe Matthews |
First Address | Pasadena, CA 91104-3613 |
Second Address | Pasadena, CA 91104-3613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 12/07/2011 |