Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PTT34000 | FL |
NPI | 1508348640 |
---|---|
Provider Name | James Francis Haughney III |
First Address | Orlando, FL 32836-5768 |
Second Address | Tampa, FL 33611-1404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2018 |
Last Update Date | 05/09/2018 |