Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA22525 | FL |
NPI | 1003584392 |
---|---|
Provider Name | Sandra Michelle Moffett |
First Address | Ocala, FL 34471-6839 |
Second Address | Ocala, FL 34471-6839 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2021 |
Last Update Date | 01/09/2021 |