Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT12119 | CA |
NPI | 1669099578 |
---|---|
Provider Name | Phyllis Ellen Nachman Edwards |
First Address | Walnut Creek, CA 94597-2168 |
Second Address | Walnut Creek, CA 94595-2203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2020 |
Last Update Date | 04/11/2020 |