Individual
BLAIZE MCMONAGLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
5121 MICHIGAN AVE, SANFORD, FL 32771-8574
(407) 346-4997
Mailing address
755 MONROE RD UNIT 470738, LAKE MONROE, FL 32747-7525
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA24352
FL
Other
Enumeration date
10/30/2019
Last updated
10/30/2019
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