Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT4711 | FL |
Y | 2251G0304X | Physical Therapist - Geriatrics | PT4711 | FL |
N | 2251N0400X | Physical Therapist - Neurology | PT4711 | FL |
N | 2251X0800X | Physical Therapist - Orthopedic | PT4711 | FL |
NPI | 1093963951 |
---|---|
Provider Name | Mrs. Yvelise Petit Stanley |
First Address | Davie, FL 33328-6303 |
Second Address | Davie, FL 33328-6303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2008 |
Last Update Date | 04/09/2008 |