Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 12107 | FL |
NPI | 1225074537 |
---|---|
Provider Name | Oliver Concepcion Flores |
First Address | New Port Richey, FL 34654-5647 |
Second Address | New Port Richey, FL 34654-5647 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 08/07/2007 |