Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA26265 | FL |
NPI | 1003280181 |
---|---|
Provider Name | Melinda Johnson-Beckford |
First Address | Tamarac, FL 33319-1904 |
Second Address | Hollywood, FL 33021-7353 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2015 |
Last Update Date | 30/11/2015 |