Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 34719 | CA |
NPI | 1003040338 |
---|---|
Provider Name | Shiju Abraham |
First Address | West Hills, CA 91307-2005 |
Second Address | West Hills, CA 91307-2005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2009 |
Last Update Date | 14/05/2009 |