Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA 18752 | FL |
NPI | 1013052125 |
---|---|
Provider Name | Lenoska Grose |
First Address | Easton, PA 18040-7958 |
Second Address | Lake Worth, FL 33467-3209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 08/07/2007 |