Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT 14083 | FL |
NPI | 1023461266 |
---|---|
Provider Name | Doan Kistner |
First Address | Fort Lauderdale, FL 33312-8202 |
Second Address | Fort Lauderdale, FL 33312-8202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2016 |
Last Update Date | 22/07/2016 |