Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013043231 |
---|---|
Provider Name | Teresa Burbach |
First Address | Pasadena, CA 91105 |
Second Address | Lancaster, CA 93534-3226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2007 |
Last Update Date | 11/09/2007 |