Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225200000X | Physical Therapy Assistant | PTA 18328 | FL |
NPI | 1023132826 |
---|---|
Provider Name | Miss Yavette Michelle Reczek |
First Address | Port Orange, FL 32127-9242 |
Second Address | Ormond Beach, FL 32174-5186 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |