Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA25440 | FL |
NPI | 1003380155 |
---|---|
Provider Name | Abby L Osborn |
First Address | Tampa, FL 33624-1184 |
Second Address | Tampa, FL 33625-5509 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2019 |
Last Update Date | 11/01/2019 |