Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics |
NPI | 1013314400 |
---|---|
Provider Name | Tiffany Poe |
First Address | Torrance, CA 90503-6668 |
Second Address | Torrance, CA 90503-6668 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2014 |
Last Update Date | 08/02/2019 |