Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 26426 | FL |
NPI | 1518235696 |
---|---|
Provider Name | Lou Demark |
First Address | Jacksonville, FL 32216-4312 |
Second Address | Jacksonville, FL 32216-4312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2011 |
Last Update Date | 05/12/2011 |