Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251P0200X | Physical Therapist - Pediatrics | PT34021 | CA |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT34021 | CA |
NPI | 1063931335 |
---|---|
Provider Name | Shannon Mcallister |
First Address | San Diego, CA 92127-5705 |
Second Address | San Diego, CA 92128-3491 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2017 |
Last Update Date | 18/09/2017 |