Rina Utami Gondokusumo

NPI #1407275738 in Mill Valley, California

Provider Information

NPI Number: 1407275738
Entity Type: Individual
Name: Rina Utami Gondokusumo
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapist
Enumeration Date: Apr 15, 2014
Last Updated: Apr 15, 2014

Practice Location

Address: 619 E BLITHEDALE AVE
City: Mill Valley
State: California
ZIP Code: 94941-1482
Phone: (415) 388-5223

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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