Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA17624 | FL |
NPI | 1013117589 |
---|---|
Provider Name | Lori Vyrne |
First Address | Boca Raton, FL 33432-3932 |
Second Address | Boca Raton, FL 33432-3932 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2007 |
Last Update Date | 23/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PTA17624 | STATE LICENSE (01) | FL |