Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 33712 | CA |
N | 2251G0304X | Physical Therapist - Geriatrics |
NPI | 1033535729 |
---|---|
Provider Name | Wingyee Sam |
First Address | Pasadena, CA 91107-4819 |
Second Address | Pasadena, CA 91107-4819 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2014 |
Last Update Date | 05/03/2014 |