Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT30064 | FL |
NPI | 1003274606 |
---|---|
Provider Name | Mirit Hazan Liebman |
First Address | Davie, FL 33328-5314 |
Second Address | Davie, FL 33328-5314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2016 |
Last Update Date | 16/01/2020 |