Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 32134 | FL |
NPI | 1003352097 |
---|---|
Provider Name | Jonathan Lee |
First Address | Marianna, FL 32446 |
Second Address | Marianna, FL 32446 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2017 |
Last Update Date | 01/05/2017 |