Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA24888 | FL |
NPI | 1003223140 |
---|---|
Provider Name | Leon Gonzalez |
First Address | Davie, FL 33325-6752 |
Second Address | Cooper City, FL 33328-3719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2014 |
Last Update Date | 21/07/2014 |