Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | PTA29881 | FL |
Y | 213ES0000X | Sports Medicine | PTA29881 | FL |
NPI | 1528643947 |
---|---|
Provider Name | Jessica Donohue |
First Address | Davie, FL 33314-1003 |
Second Address | Weston, FL 33326-3639 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2021 |
Last Update Date | 17/03/2021 |