Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA9371 | FL |
NPI | 1003073230 |
---|---|
Provider Name | Dawn M Titto |
First Address | Pompano Beach, FL 33060-7133 |
Second Address | Pompano Beach, FL 33060-7133 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2008 |
Last Update Date | 16/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PTA9371 | PTA LICENSE NO (01) | FL |