Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT34169 | FL |
NPI | 1073145223 |
---|---|
Provider Name | Manali Patel |
First Address | Lutz, FL 33549-6958 |
Second Address | Lutz, FL 33549-6958 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2020 |
Last Update Date | 06/02/2020 |