Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 9129 | CA |
NPI | 1194259887 |
---|---|
Provider Name | Stanley Conte |
First Address | San Carlos, CA 94070-4283 |
Second Address | San Carlos, CA 94070-4283 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2017 |
Last Update Date | 19/04/2017 |