Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA 22360 | FL |
NPI | 1003116476 |
---|---|
Provider Name | Sheyna Buck |
First Address | Saint Augustine, FL 32092-5073 |
Second Address | Saint Augustine, FL 32092-5073 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2010 |
Last Update Date | 01/11/2010 |