Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA22295 | FL |
NPI | 1013288026 |
---|---|
Provider Name | Lauren M Breuer |
First Address | Cocoa, FL 32927-8621 |
Second Address | Titusville, FL 32796-2147 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2012 |
Last Update Date | 23/01/2012 |