| NPI | 1104995406 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNNIE LYNN PUCCIO Physical Therapy Assistant 561-478-3702 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL PTA19316) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2020-08-22 |