Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA24182 | FL |
NPI | 1013468503 |
---|---|
Provider Name | James Greg Moore |
First Address | Sarasota, FL 34235-6640 |
Second Address | Sarasota, FL 34235-6640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2016 |
Last Update Date | 19/10/2016 |