Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT008304 | GA |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT 24202 | FL |
NPI | 1083650360 |
---|---|
Provider Name | Mr. Steven Elton |
First Address | Bradenton, FL 34210-3145 |
Second Address | Bradenton, FL 34210-3145 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 14/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GZ664Z | (02) | FL |