Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA26088 | FL |
NPI | 1013373901 |
---|---|
Provider Name | Heather Gingrasso |
First Address | Clermont, FL 34712-0547 |
Second Address | Clermont, FL 34711-6816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2016 |
Last Update Date | 07/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PTA26088 | FLORIDA PTA LICENSE (01) | FL |