Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA 19517 | FL |
NPI | 1003975756 |
---|---|
Provider Name | Sandra Medeiros |
First Address | Coral Springs, FL 33076-2804 |
Second Address | Coral Springs, FL 33071-6132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 08/07/2007 |