Individual
MRS. ANTOINETTE MARIA ELISABETH PULVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.T.
Contact information
Practice address
1215 E ORANGE ST, LAKELAND, FL 33801-5762
(863) 802-3800
(863) 802-0480
Mailing address
1215 E ORANGE ST, LAKELAND, FL 33801-5762
(863) 802-3800
(863) 802-0480
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
P12209
NC
2251P0200X
Pediatric Physical Therapist
Primary
PT 24860
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407834021
GROUP NPI
FL
01
—
592984541
GROUP TAX ID
FL
01
—
Y905L
BLUE CROSS BLUE SHIELD
FL
Enumeration date
08/05/2009
Last updated
08/05/2009
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