Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT4767 | FL |
NPI | 1003036625 |
---|---|
Provider Name | Debra M Grande |
First Address | Chipley, FL 32428-1855 |
Second Address | Chipley, FL 32428-1855 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 08/07/2007 |