Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 032186 | NY |
N | 225100000X | Physical Therapist | PT25935 | FL |
NPI | 1003144155 |
---|---|
Provider Name | Eleanor Innocent |
First Address | Temple Terrace, FL 33637-1045 |
Second Address | Tampa, FL 33613-4613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2009 |
Last Update Date | 05/02/2013 |