Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA2368 | FL |
NPI | 1003408196 |
---|---|
Provider Name | Waddie Freeman |
First Address | Plant City, FL 33563-3377 |
Second Address | Plant City, FL 33563-3377 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2021 |
Last Update Date | 09/02/2021 |