Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT 33635 | CA |
NPI | 1003033176 |
---|---|
Provider Name | Ryan Michael Somers |
First Address | Santa Ana, CA 92705-6103 |
Second Address | Lake Forest, CA 92630-6303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 23/05/2016 |