Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT60403909 | WA |
NPI | 1407374663 |
---|---|
Provider Name | Mr. Danilo Tomas M. Hallares |
First Address | Coral Springs, FL 33065-4223 |
Second Address | Coral Springs, FL 33065-4223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2017 |
Last Update Date | 07/09/2017 |