Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA25725 | FL |
NPI | 1003372517 |
---|---|
Provider Name | Theresa Ryan Sanchez |
First Address | Port Saint Lucie, FL 34953-3235 |
Second Address | Vero Beach, FL 32960-3641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2019 |
Last Update Date | 20/02/2019 |