Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA009441 | FL |
NPI | 1023132743 |
---|---|
Provider Name | Stephanie J Justine |
First Address | Stuart, FL 34997-6531 |
Second Address | Jupiter, FL 33458-7205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |