Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003936329 |
---|---|
Provider Name | Terrie Addison |
First Address | Culver City, CA 90232-2732 |
Second Address | Culver City, CA 90232-2732 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 14/07/2015 |