Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | AT4701 | CA |
NPI | 1013028760 |
---|---|
Provider Name | Suzanne M Degan |
First Address | Sacramento, CA 95865-5228 |
Second Address | Roseville, CA 95661-3087 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |