Individual
AMY EVANS WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.A.
Contact information
Practice address
3910 S WASHINGTON AVE, SUITE 107, TITUSVILLE, FL 32780-5844
(321) 383-1411
(321) 383-1477
Mailing address
3910 S WASHINGTON AVE, SUITE 107, TITUSVILLE, FL 32780-5844
(321) 383-1411
(321) 383-1477
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 15667
FL
Other
Enumeration date
09/26/2007
Last updated
08/03/2011
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