Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT5491 | FL |
N | 2251G0304X | Physical Therapist - Geriatrics | PT5491 | FL |
NPI | 1053668863 |
---|---|
Provider Name | Dr. Deborah Lynn Ronis |
First Address | Fort Myers, FL 33919-3402 |
Second Address | Fort Myers, FL 33919-3402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2012 |
Last Update Date | 10/08/2012 |