Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA20798 | FL |
NPI | 1013280007 |
---|---|
Provider Name | Brandi Jean Dogoda |
First Address | Panama City, FL 32404-3410 |
Second Address | Callaway, FL 32404-6132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2012 |
Last Update Date | 22/02/2012 |