Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 36267 | FL |
NPI | 1194209205 |
---|---|
Provider Name | Jack Malafronte |
First Address | Tampa, FL 33611-2812 |
Second Address | Tampa, FL 33629-6313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2018 |
Last Update Date | 09/11/2020 |