Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT35712 | FL |
N | 2251P0200X | Physical Therapist - Pediatrics | PT35712 | FL |
NPI | 1033735139 |
---|---|
Provider Name | Kristen Duncan |
First Address | Jacksonville, FL 32258-6520 |
Second Address | Jacksonville, FL 32216-4252 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2020 |
Last Update Date | 29/06/2020 |