Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT33514 | FL |
N | 2251X0800X | Physical Therapist - Orthopedic | PT33514 | FL |
NPI | 1043705783 |
---|---|
Provider Name | Magdalena Wiktoria Bachan |
First Address | Tampa, FL 33607-1412 |
Second Address | Tampa, FL 33607-1412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2018 |
Last Update Date | 27/01/2020 |