Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT26942 | FL |
NPI | 1235535824 |
---|---|
Provider Name | Catherine Therese Montojo |
First Address | Pensacola, FL 32503 |
Second Address | Pensacola, FL 32503-6608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2014 |
Last Update Date | 10/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
M532138818820 | DRIVER'S LICENSE (01) | FL |