Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 29813 | FL |
NPI | 1013559731 |
---|---|
Provider Name | Joshua Timmons |
First Address | Lake City, FL 32025-5746 |
Second Address | Lake City, FL 32025-5746 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2019 |
Last Update Date | 14/10/2019 |