Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT36611 | FL |
NPI | 1063008357 |
---|---|
Provider Name | Earl Norbert O. Dimaano |
First Address | Jacksonville, FL 32210-6788 |
Second Address | Jacksonville, FL 32210-6788 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2020 |
Last Update Date | 21/12/2020 |