Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT 40369 | CA |
NPI | 1003241738 |
---|---|
Provider Name | Sean S Mcintire |
First Address | Encinitas, CA 92024-2811 |
Second Address | San Diego, CA 92121-1982 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2013 |
Last Update Date | 10/03/2014 |