| NPI | 1518389014 |
|---|---|
| Former Name | TAMMY LYNNE POTTHOFF ORTEGA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA 24505) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2100840) |
| Enumeration Date | 2014-01-17 |
| Last Update Date | 2014-01-17 |