| NPI | 1962834275 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL LISTER WHAN Owner/Provider 760-715-9526 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT33897) |
| Enumeration Date | 2013-08-08 |
| Last Update Date | 2019-05-30 |