Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA25828 | FL |
NPI | 1013487511 |
---|---|
Provider Name | Julie M Cortello |
First Address | Lakeland, FL 33805-3722 |
Second Address | Lakeland, FL 33805-3722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2018 |
Last Update Date | 28/11/2018 |