Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 4851 | CA |
NPI | 1003025610 |
---|---|
Provider Name | Tamra Koester |
First Address | La Habra, CA 90631-6767 |
Second Address | Laguna Hills, CA 92653-1347 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 08/07/2007 |