Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 51574 | CA |
NPI | 1003574849 |
---|---|
Provider Name | Shannon Patterson |
First Address | Fullerton, CA 92835-1001 |
Second Address | Huntington Beach, CA 92647-5495 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2021 |
Last Update Date | 29/11/2021 |