Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225200000X | Physical Therapy Assistant | 1564 | CT |
Y | 225200000X | Physical Therapy Assistant | PTA 26011 | FL |
N | 225700000X | Massage Therapist | 1315 | CT |
N | 225700000X | Massage Therapist | MA79747 | FL |
NPI | 1003289570 |
---|---|
Provider Name | Jayna Dinsmore |
First Address | Lakeland, FL 33803-5622 |
Second Address | Lakeland, FL 33803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2015 |
Last Update Date | 04/02/2016 |