Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT29457 | FL |
N | 2251P0200X | Physical Therapist - Pediatrics | PT29457 | FL |
NPI | 1023427366 |
---|---|
Provider Name | Trystin Ann Enea |
First Address | Miami, FL 33130-4100 |
Second Address | North Miami, FL 33181-1423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2014 |
Last Update Date | 12/08/2014 |