Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT35136 | FL |
NPI | 1033734405 |
---|---|
Provider Name | Macey Cherie Thornburg |
First Address | Miami, FL 33156-8051 |
Second Address | Miami, FL 33186-4488 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2020 |
Last Update Date | 11/06/2020 |