Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA16342 | FL |
NPI | 1023049319 |
---|---|
Provider Name | Dawn Alisa Haynes |
First Address | Boca Raton, FL 33434 |
Second Address | Boca Raton, FL 33434 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PTA16342 | PTA LICENSE (01) | FL |