Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PTT30799 | FL |
N | 2251N0400X | Physical Therapist - Neurology | PTT30799 | FL |
NPI | 1104295617 |
---|---|
Provider Name | Dr. Michaela Bundy |
First Address | Tampa, FL 33612 |
Second Address | Tampa, FL 33612-4745 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2015 |
Last Update Date | 29/01/2016 |