Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013281021 |
---|---|
Provider Name | Terri Yancey |
First Address | Altadena, CA 91001-4352 |
Second Address | El Monte, CA 91731-2202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2012 |
Last Update Date | 08/03/2012 |