Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA28794 | FL |
NPI | 1013483056 |
---|---|
Provider Name | Jayna Lacko |
First Address | Indian Harbour Beach, FL 32937-3566 |
Second Address | Indian Harbour Beach, FL 32937-3566 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2018 |
Last Update Date | 17/10/2018 |