Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT28400 | FL |
NPI | 1144866674 |
---|---|
Provider Name | Lindsey Gorrin |
First Address | Tarpon Springs, FL 34689-2725 |
Second Address | Tarpon Springs, FL 34689-5709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2019 |
Last Update Date | 19/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT28400 | LICENSE (01) | FL |