Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PT4709 | FL |
NPI | 1346372836 |
---|---|
Provider Name | Kevin Wayne Vanwart |
First Address | Ocala, FL 34480-7275 |
Second Address | Leesburg, FL 34748 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2007 |
Last Update Date | 26/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT4709 | STATE (01) | FL |