Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA27353 | FL |
NPI | 1013516285 |
---|---|
Provider Name | Natasha K Mannel |
First Address | Callahan, FL 32011-3805 |
Second Address | Jacksonville, FL 32204-4189 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2020 |
Last Update Date | 20/10/2020 |