Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PT10558 | FL |
NPI | 1508917758 |
---|---|
Provider Name | Ms. Nadine Rose De Freitas |
First Address | Titusville, FL 32780-5914 |
Second Address | Merritt Island, FL 32953-3490 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2007 |
Last Update Date | 20/07/2014 |