Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 18813 | FL |
NPI | 1003064940 |
---|---|
Provider Name | Miss Rosina Ann Marzullo |
First Address | Panama City Beach, FL 32408-3601 |
Second Address | Panama City Beach, FL 32408-3601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2008 |
Last Update Date | 04/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
18813 | PTA LICENSE NUMBER (01) | FL |