Heather Diana Profetto PTA

NPI 1316379332 - Physical Therapy Assistant - 225200000X

NPI Details
NPI 1316379332
Gender Female
Enumeration Date 08/01/2013
Last Updated 08/01/2013
Entity Type Individual
Active Over 3 years ago
Practice Location
8505 SAN JOSE BLVD
JACKSONVILLE FL, 32217-4225, US
Phone (904) 419-6101
Fax
Business Location
10746 LIPPIZAN DR
JACKSONVILLE FL, 32257-3657, US
Phone (904) 993-2741
Fax
Toxanomy
Taxonomy Code 225200000X
License State Florida
License Number PTA 21452
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According to our database, Heather Diana Profetto PTA NPI is 1316379332, taxonomy code is 225200000X and license number is PTA 21452, license state is located at Florida. Heather Diana Profetto PTA physically located at 8505 San Jose Blvd, Jacksonville FL, 32217-4225. NPI Number Heather Diana Profetto PTA has the Individual type.

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1316379332 NPI number is provided on an as is basis without warranty of any kind. 1316379332 is maintained by the National Plan & Provider Enumeration System. The contents of Heather Diana Profetto PTA are for informational purposes only.