Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT22161 | CA |
NPI | 1104056712 |
---|---|
Provider Name | Wilma Rodeen |
First Address | Santa Clarita, CA 91351-2357 |
Second Address | Santa Clarita, CA 91351-2357 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2009 |
Last Update Date | 16/07/2009 |