Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1013369610 |
---|---|
Provider Name | Lauren Dutton |
First Address | Lake City, FL 32025-5808 |
Second Address | Lake City, FL 32025-5808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2016 |
Last Update Date | 07/07/2016 |