Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA26689 | FL |
NPI | 1003428103 |
---|---|
Provider Name | Adolfo Martin |
First Address | Miami Lakes, FL 33014-2422 |
Second Address | Miami Lakes, FL 33014-2422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2020 |
Last Update Date | 19/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
M635-013-77-448-0 | (05) | FL |