Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251G0304X | Physical Therapist - Geriatrics | 10584 | WI |
Y | 2251G0304X | Physical Therapist - Geriatrics | PT12093 | CA |
NPI | 1154363422 |
---|---|
Provider Name | Sophia A Risorto |
First Address | Cathedral City, CA 92234-7248 |
Second Address | Cathedral City, CA 92234-7248 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 09/04/2008 |