Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA1683 | FL |
NPI | 1003909433 |
---|---|
Provider Name | Mary Ragusa |
First Address | Edgewater, FL 32141-6120 |
Second Address | Orange Park, FL 32073-4847 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2006 |
Last Update Date | 08/07/2007 |