Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | ME69095 | FL |
NPI | 1144274796 |
---|---|
Provider Name | Dr. Theresa E Rattey |
First Address | Lake Worth, FL 33461-4746 |
Second Address | Lake Worth, FL 33461-4746 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 10/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000171200 | (05) | FL |
G26449 | (02) | FL |