Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA22705 | FL |
NPI | 1013268770 |
---|---|
Provider Name | Mrs. Leslie Klinck |
First Address | Lynn Haven, FL 32444-5360 |
Second Address | Lynn Haven, FL 32444-5360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2012 |
Last Update Date | 20/09/2012 |