Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA24145 | FL |
NPI | 1003140393 |
---|---|
Provider Name | Erin Gardner |
First Address | Riverview, FL 33578-7402 |
Second Address | Riverview, FL 33578-7402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2009 |
Last Update Date | 14/11/2013 |