Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | CA | |
N | 225100000X | Physical Therapist | PT 13302 | CA |
NPI | 1003036930 |
---|---|
Provider Name | Vickie Beltramo |
First Address | Yreka, CA 96097-3450 |
Second Address | Yreka, CA 96097 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 29/08/2019 |