Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 19266 | FL |
NPI | 1003402306 |
---|---|
Provider Name | Jan Pasour |
First Address | Pensacola, FL 32506-3913 |
Second Address | Pensacola, FL 32506-3913 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2020 |
Last Update Date | 21/12/2020 |