Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 23334 | FL |
NPI | 1003008491 |
---|---|
Provider Name | Christine J De Graan |
First Address | Miami Beach, FL 33141-3961 |
Second Address | Miami, FL 33136-1005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2007 |
Last Update Date | 10/08/2007 |