Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT10830 | CA |
NPI | 1063550655 |
---|---|
Provider Name | Susanne Goade Vertin |
First Address | Los Gatos, CA 95032-1417 |
Second Address | Los Gatos, CA 95032-1417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2007 |
Last Update Date | 08/07/2007 |