Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT022076 | PA |
NPI | 1003249038 |
---|---|
Provider Name | Sara Brett |
First Address | Tampa, FL 33609-1140 |
Second Address | Tampa, FL 33609-1140 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2013 |
Last Update Date | 13/08/2013 |