Individual
HOLLY WAITES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
22135 THUNDERBOLT DR, SONORA, CA 95370-8915
(530) 388-8247
Mailing address
22135 THUNDERBOLT DR, SONORA, CA 95370-8915
(530) 388-8247
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
8397
CA
Other
Enumeration date
09/13/2010
Last updated
09/13/2010
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