Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA20620 | FL |
NPI | 1003945387 |
---|---|
Provider Name | Stacey Coleman Hess |
First Address | Lakeland, FL 33811-2964 |
Second Address | Lakeland, FL 33801-5762 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PTA20620 | FL PROFESSIONAL LICENSE (01) | FL |