Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 299452 | CA |
N | 2251E1200X | Ergonomics | 299452 | CA |
N | 225XE1200X | Ergonomics | 299452 | CA |
N | 2251S0007X | Physical Therapist - Sports | 299452 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | 299452 | CA |
NPI | 1649865643 |
---|---|
Provider Name | Timothy Alexander Wertz |
First Address | San Diego, CA 92126-3263 |
Second Address | San Diego, CA 92126-4713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2021 |
Last Update Date | 02/03/2021 |