Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA21516 | FL |
NPI | 1013140060 |
---|---|
Provider Name | Eduardo Palacios |
First Address | Palmetto Bay, FL 33157-6422 |
Second Address | Palmetto Bay, FL 33157-6422 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2009 |
Last Update Date | 25/08/2009 |