| NPI | 1649255605 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTIE JOHANNA VAN WERKUM-GLIDDEN Physical Therapist 707-445-9150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2020-08-22 |