Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT20460 | FL |
NPI | 1003084187 |
---|---|
Provider Name | Mr. Ronney Etienne |
First Address | Brandon, FL 33511-8101 |
Second Address | Brandon, FL 33511-8101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2008 |
Last Update Date | 12/02/2008 |