Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251N0400X | Physical Therapist - Neurology | PT34236 | CA |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT34236 | CA |
NPI | 1699958058 |
---|---|
Provider Name | Stacey Laibow |
First Address | Tustin, CA 92780-3655 |
Second Address | Tustin, CA 92780-3655 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2007 |
Last Update Date | 07/12/2007 |