Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | FL |
NPI | 1295236057 |
---|---|
Provider Name | Mr. Stephone Delano Devante Baker |
First Address | Orlando, FL 32818-1275 |
Second Address | Daytona Beach, FL 32114-3012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2018 |
Last Update Date | 26/02/2018 |