Individual
TODD VAN ETTEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
26318 MISTY GLN, LAKE FOREST, CA 92630-7249
(949) 202-8905
Mailing address
26318 MISTY GLN, LAKE FOREST, CA 92630-7249
(949) 202-8905
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
9605
CA
Other
Enumeration date
02/11/2015
Last updated
02/11/2015
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