Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 40303 | CA |
NPI | 1184094948 |
---|---|
Provider Name | Queen Phamle |
First Address | Santa Clara, CA 95050-6457 |
Second Address | Santa Clara, CA 95051-5173 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2015 |
Last Update Date | 03/01/2022 |