Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | PT13260 | FL |
Y | 213ES0000X | Sports Medicine | PT13260 | FL |
NPI | 1376069732 |
---|---|
Provider Name | Aletha Braithwaite |
First Address | Apopka, FL 32703-4147 |
Second Address | Apopka, FL 32703-4147 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2017 |
Last Update Date | 17/08/2017 |