Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT12035 | FL |
NPI | 1013937317 |
---|---|
Provider Name | Mrs. Debra Sells |
First Address | Jacksonville, FL 32223-8628 |
Second Address | Jacksonville, FL 32223-8628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Y5078 | BLUE CROSS BLUE SHIELD (01) | FL |