Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 31525 | FL |
Y | 213ES0000X | Sports Medicine | 31525 | FL |
N | 225100000X | Physical Therapist | 31525 | FL |
N | 2251X0800X | Physical Therapist - Orthopedic | 31525 | FL |
NPI | 1003266537 |
---|---|
Provider Name | Christiana Marron |
First Address | Fort Lauderdale, FL 33301-2020 |
Second Address | Fort Lauderdale, FL 33301-2020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2016 |
Last Update Date | 11/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31525 | CASH PAY PRACTICE (01) | FL |