Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant |
NPI | 1003949413 |
---|---|
Provider Name | John Stuart Shoffner |
First Address | Winter Haven, FL 33884-2347 |
Second Address | Winter Haven, FL 33881-1349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 08/07/2007 |