Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA21823 | FL |
NPI | 1013553486 |
---|---|
Provider Name | Cassandra Rodriguez |
First Address | Key West, FL 33040-3815 |
Second Address | Key West, FL 33040-4314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2019 |
Last Update Date | 20/11/2019 |