| NPI | 1225029630 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYLE MELVIN ANDERSEN Co Owner 209-549-4626 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy |
| 225X00000X Occupational Therapist | |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: CA 0134075) | |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2017-04-17 |