Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251X0800X | Physical Therapist - Orthopedic | PT22806 | FL |
Y | 225X00000X | Occupational Therapist | OT 12112 | FL |
NPI | 1013130434 |
---|---|
Provider Name | Bridget Leanne Calkins |
First Address | St Augustine, FL 32086-1802 |
Second Address | St Augustine, FL 32086-3251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 15/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006371000 | (05) | FL |
GJ328Y | (02) | FL |