Sangdae Park
Physical Therapist in Sebastopol, CA. Individual provider (NPI-1).
NPI number1922543875
StatusActive
Last updated in NPPESJan 2, 2017
Details
- NPI
- 1922543875
- Entity type
- Individual (NPI-1)
- Name
- Sangdae Park
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jan 2, 2017
- Last updated
- Jan 2, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225100000X | Physical Therapist | 43130 | CA | Yes |
Practice location
556 Lyding LnSebastopol, CA 95472-3311
Phone 202-870-0644
Mailing address
556 Lyding LnSebastopol, CA 95472-3311
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All 15 Physical Therapist providers in Sebastopol · All 688 providers in Sebastopol
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