Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant |
NPI | 1013555275 |
---|---|
Provider Name | Carmen Martinez |
First Address | Doral, FL 33166-6202 |
Second Address | Miami, FL 33165-3313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2019 |
Last Update Date | 18/12/2019 |