Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA20429 | FL |
NPI | 1003908401 |
---|---|
Provider Name | Lisa Garrett |
First Address | Branford, FL 32008-1208 |
Second Address | Orange Park, FL 32073-4847 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2006 |
Last Update Date | 08/07/2007 |