Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT18834 | FL |
N | 2251P0200X | Physical Therapist - Pediatrics | PT18834 | FL |
NPI | 1083621197 |
---|---|
Provider Name | Camille A. Drennan |
First Address | Stuart, FL 34997-6235 |
Second Address | Stuart, FL 34997-6235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 06/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
680687296 | (05) | FL |
886424100 | (05) | FL |