Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PTA18838 | FL |
NPI | 1407266992 |
---|---|
Provider Name | Michael Pearce |
First Address | Port Saint Lucie, FL 34983-1842 |
Second Address | Port Saint Lucie, FL 34983-1842 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2014 |
Last Update Date | 06/05/2014 |