Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 24657 | CA |
NPI | 1003917451 |
---|---|
Provider Name | Shannon Injety |
First Address | Colton, CA 92324-3941 |
Second Address | Colton, CA 92324-3941 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 08/07/2007 |