| NPI | 1073664165 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTEN ANN PAYNE Physical Therapist 209-216-3360 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 24553) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 25198) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2015-08-12 |