Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 291119 | CA |
NPI | 1073067104 |
---|---|
Provider Name | Tina Lee |
First Address | Cypress, CA 90630-5489 |
Second Address | Cypress, CA 90630-5489 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2016 |
Last Update Date | 05/08/2016 |