Individual
REYNA ANGELICA HENRIQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
7745 CARRIAGE POINTE DR, GIBSONTON, FL 33534-3004
(813) 525-1476
Mailing address
7745 CARRIAGE POINTE DR, GIBSONTON, FL 33534-3004
(813) 525-1476
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA30937
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA30937
PTA LICENSE
FL
Enumeration date
04/28/2021
Last updated
04/28/2021
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