Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PTA20084 | FL |
NPI | 1376800383 |
---|---|
Provider Name | Mr. Gregory Michael Bianchino |
First Address | Lakeland, FL 33809-3926 |
Second Address | Lakeland, FL 33809-3926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2012 |
Last Update Date | 15/04/2012 |