Individual
ALIA J WANTUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4606 CLYDE MORRIS BLVD STE 1D, PORT ORANGE, FL 32129-7453
(386) 492-2986
Mailing address
1820 CREEKWATER BLVD, PORT ORANGE, FL 32128-4088
(386) 871-4431
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA30714
FL
Other
Enumeration date
11/23/2020
Last updated
11/23/2020
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