Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 24130 | MA |
N | 2251S0007X | Physical Therapist - Sports | 300336 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | 24130 | MA |
Y | 2251X0800X | Physical Therapist - Orthopedic | 300336 | CA |
NPI | 1508428145 |
---|---|
Provider Name | Victor Wei |
First Address | Los Angeles, CA 90045-1543 |
Second Address | Los Angeles, CA 90045-1543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2019 |
Last Update Date | 18/11/2021 |