Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT20592 | FL |
NPI | 1114155363 |
---|---|
Provider Name | Mrs. Lauren Cozma |
First Address | Fort Walton Beach, FL 32548-4960 |
Second Address | Fort Walton Beach, FL 32548-4960 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2009 |
Last Update Date | 26/06/2009 |