Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT18024 | CA |
N | 2251C2600X | Cardiopulmonary | PT18024 | CA |
N | 2251E1200X | Ergonomics | PT18024 | CA |
N | 225XE1200X | Ergonomics | PT18024 | CA |
N | 2251E1300X | Electrophysiology, Clinical | PT18024 | CA |
N | 2251G0304X | Physical Therapist - Geriatrics | PT18024 | CA |
N | 2251H1200X | Hand | PT18024 | CA |
N | 2251N0400X | Physical Therapist - Neurology | PT18024 | CA |
N | 2251S0007X | Physical Therapist - Sports | PT18024 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT18024 | CA |
NPI | 1316089287 |
---|---|
Provider Name | Sheri Pueblo |
First Address | Mammoth Lakes, CA 93546-0660 |
Second Address | Mammoth Lakes, CA 93546-0660 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 08/07/2007 |