Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 5073 | SC |
Y | 2251S0007X | Physical Therapist - Sports | 23468 | FL |
NPI | 1306941364 |
---|---|
Provider Name | Dr. James Craig Garrison |
First Address | Tampa, FL 33612-4742 |
Second Address | Tampa, FL 33613-4706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 23/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5073 | LIC (01) | SC |