Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT27903 | FL |
NPI | 1043659063 |
---|---|
Provider Name | Dr. Samantha Larson Anello |
First Address | Jacksonville Beach, FL 32250-2983 |
Second Address | Jacksonville Beach, FL 32250-6073 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2013 |
Last Update Date | 24/06/2013 |