Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PT15979 | FL |
NPI | 1043764483 |
---|---|
Provider Name | Mr. Tonny Vandehee |
First Address | Naples, FL 34119-8672 |
Second Address | Naples, FL 34119-8672 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2016 |
Last Update Date | 14/08/2016 |