Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT 30554 | FL |
NPI | 1104202555 |
---|---|
Provider Name | Ashleigh Darnell |
First Address | Saint Cloud, FL 34769-1636 |
Second Address | Saint Cloud, FL 34769-1636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2015 |
Last Update Date | 08/08/2015 |