Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA17988 | FL |
NPI | 1013080910 |
---|---|
Provider Name | Debra B Mann |
First Address | Melbourne, FL 32901-7396 |
Second Address | Melbourne, FL 32901-7396 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PTA17988 | LICENSE (01) | FL |