Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT36180 | FL |
N | 2251X0800X | Physical Therapist - Orthopedic | PT36180 | FL |
NPI | 1063072379 |
---|---|
Provider Name | Hayley Christina Fake |
First Address | Clearwater, FL 33764-7676 |
Second Address | Clearwater, FL 33763-4403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2019 |
Last Update Date | 06/11/2020 |