Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | PTA24761 | FL |
N | 213ES0000X | Sports Medicine | PTA24761 | FL |
Y | 225200000X | Physical Therapy Assistant | PTA24761 | FL |
NPI | 1265056931 |
---|---|
Provider Name | Pamela Dorman |
First Address | Melbourne, FL 32940-2239 |
Second Address | Melbourne, FL 32940-2240 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2020 |
Last Update Date | 29/05/2020 |