Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 297433 |
NPI | 1083129902 |
---|---|
Provider Name | Samantha Raba |
First Address | Sayreville, NJ 08872-1258 |
Second Address | San Diego, CA 92123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2017 |
Last Update Date | 09/11/2019 |