Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT9967 | FL |
NPI | 1235802059 |
---|---|
Provider Name | Clarivi Noblejas |
First Address | Sanford, FL 32771-5401 |
Second Address | Sanford, FL 32771-5401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2021 |
Last Update Date | 28/07/2021 |