Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 22577 | FL |
N | 2251S0007X | Physical Therapist - Sports | 1818 | MN |
NPI | 1144323197 |
---|---|
Provider Name | Patricia Roholt |
First Address | Key West, FL 33040-8800 |
Second Address | Key West, FL 33040-6964 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 08/07/2007 |