Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT19637 | FL |
N | 2251S0007X | Physical Therapist - Sports | PT19637 | FL |
N | 2251X0800X | Physical Therapist - Orthopedic | PT19637 | FL |
NPI | 1275576456 |
---|---|
Provider Name | Benjamin Scott Rawitt |
First Address | St Augustine, FL 32086-5300 |
Second Address | St Augustine, FL 32086-5300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 08/07/2007 |