Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT23161 | FL |
NPI | 1003211509 |
---|---|
Provider Name | Roselle Joyce Beltran |
First Address | Venice, FL 34285-7123 |
Second Address | Venice, FL 34293 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2014 |
Last Update Date | 21/10/2016 |