Individual
HEATHER DIANA PROFETTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
8505 SAN JOSE BLVD, JACKSONVILLE, FL 32217-4225
(904) 419-6101
Mailing address
10746 LIPPIZAN DR, JACKSONVILLE, FL 32257-3657
(904) 993-2741
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 21452
FL
Other
Enumeration date
08/01/2013
Last updated
08/01/2013
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