Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA12195 | FL |
NPI | 1003866450 |
---|---|
Provider Name | Diane Sampson |
First Address | Village Of Palmetto Bay, FL 33157-6416 |
Second Address | Village Of Palmetto Bay, FL 33157-6416 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 08/07/2007 |