Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 4822 | CA |
NPI | 1023028594 |
---|---|
Provider Name | Tricia Shelton |
First Address | Foothill Ranch, CA 92610-2334 |
Second Address | Lake Forest, CA 92630-1617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 08/07/2007 |