Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT22266 | FL |
N | 2251S0007X | Physical Therapist - Sports | PT22266 | FL |
NPI | 1154535078 |
---|---|
Provider Name | Mr. Lawrence Eric Jaffe |
First Address | Parkland, FL 33067-3942 |
Second Address | Boynton Beach, FL 33437-6156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 08/07/2007 |