Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | POR82 | FL |
NPI | 1417987058 |
---|---|
Provider Name | Paul Rothman |
First Address | Clearwater, FL 33756-3398 |
Second Address | Clearwater, FL 33756-3395 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 08/07/2007 |