Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070.022877 | IL |
N | 2251G0304X | Physical Therapist - Geriatrics | PT175690 | FL |
NPI | 1225563182 |
---|---|
Provider Name | Amy Simonetta |
First Address | Pensacola, FL 32503-4331 |
Second Address | Jay, FL 32565-1104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2017 |
Last Update Date | 25/01/2021 |