Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 14598 | CA |
NPI | 1720287568 |
---|---|
Provider Name | Wanda Jk Crook |
First Address | San Diego, CA 92127-1677 |
Second Address | San Diego, CA 92127-1677 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2007 |
Last Update Date | 13/06/2014 |