Individual
MRS. SHELBY FORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
3301 TARECO DR, LOS ANGELES, CA 90068-1527
(323) 333-2915
Mailing address
3301 TARECO DR, LOS ANGELES, CA 90068-1527
(323) 333-2915
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT27055
CA
Other
Enumeration date
12/17/2009
Last updated
12/17/2009
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