Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 293828 | CA |
NPI | 1104336692 |
---|---|
Provider Name | Sunny Holmes |
First Address | La Canada, CA 91011-2332 |
Second Address | Chatsworth, CA 91311-1350 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2017 |
Last Update Date | 19/03/2021 |