Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225700000X | Massage Therapist | MA21615 | FL |
Y | 226300000X | Kinesiotherapist | MA21615 | FL |
NPI | 1902030802 |
---|---|
Provider Name | Timothy A Agew |
First Address | Sarasota, FL 34237-3218 |
Second Address | Sarasota, FL 34237-3218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2009 |
Last Update Date | 06/05/2009 |