Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT005235 | GA |
Y | 225100000X | Physical Therapist | PT28203 | FL |
N | 2251N0400X | Physical Therapist - Neurology | PT005235 | GA |
N | 2251P0200X | Physical Therapist - Pediatrics | PT005235 | GA |
NPI | 1114978756 |
---|---|
Provider Name | Mrs. Donna Browder Grace |
First Address | St Augustine, FL 32080-8425 |
Second Address | St Augustine, FL 32080-8425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 30/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000902767A | (05) | GA |