Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | ||
Y | 2251X0800X | Physical Therapist - Orthopedic | PT3342 | FL |
NPI | 1497152284 |
---|---|
Provider Name | Robert Emil Panico |
First Address | Jupiter, FL 33468-2169 |
Second Address | Jupiter, FL 33458-7191 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2014 |
Last Update Date | 24/11/2014 |