Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT7069 | FL |
NPI | 1003155680 |
---|---|
Provider Name | Roselie Isidro Perocillo |
First Address | Pinellas Park, FL 33782-2241 |
Second Address | Pinellas Park, FL 33782-2336 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2013 |
Last Update Date | 08/03/2019 |