Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT1835 | FL |
NPI | 1003021395 |
---|---|
Provider Name | Annamarie Chestnut |
First Address | Boca Raton, FL 33433-5511 |
Second Address | Boca Raton, FL 33433-5511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 08/07/2007 |