Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 1087294 | TX |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT30681 | FL |
NPI | 1073802831 |
---|---|
Provider Name | Marie Swanson |
First Address | Tampa, FL 33609-1251 |
Second Address | Tampa, FL 33609-1251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2011 |
Last Update Date | 29/09/2015 |