Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | PT37077 | FL |
NPI | 1023683919 |
---|---|
Provider Name | Brooke Alyssa Pridgeon |
First Address | Bel Air, MD 21015-1591 |
Second Address | Sarasota, FL 34236-1542 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2021 |
Last Update Date | 24/05/2021 |