Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA356 | FL |
NPI | 1003157652 |
---|---|
Provider Name | Mrs. Janet Parham Gardner |
First Address | Lutz, FL 33559-8222 |
Second Address | Lutz, FL 33559-8222 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2013 |
Last Update Date | 06/03/2013 |