Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA27966 | FL |
NPI | 1003342114 |
---|---|
Provider Name | Kaitlyn Peters |
First Address | Spring Hill, FL 34608-2927 |
Second Address | Springhill, FL 34608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2017 |
Last Update Date | 01/05/2018 |