Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT14506 | FL |
NPI | 1104073444 |
---|---|
Provider Name | Mr. Petrus G Cronje |
First Address | Port Orange, FL 32128-6073 |
Second Address | Port Orange, FL 32128-6073 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2008 |
Last Update Date | 19/08/2008 |