Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA 18913 | FL |
NPI | 1003046301 |
---|---|
Provider Name | Jamie Butters |
First Address | Winter Haven, FL 33884-1468 |
Second Address | Winter Haven, FL 33884-1468 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2009 |
Last Update Date | 21/07/2009 |