Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | PTA23143 | FL |
Y | 213ES0000X | Sports Medicine | PTA23143 | FL |
NPI | 1376933507 |
---|---|
Provider Name | Jessica Benshoshan |
First Address | Davie, FL 33314-1841 |
Second Address | Davie, FL 33314-1841 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2015 |
Last Update Date | 26/01/2015 |