Individual
MERRY DUBOSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
5988 CREEKSIDE CIR, CRESTVIEW, FL 32536-9359
(850) 240-3869
Mailing address
5988 CREEKSIDE CIR, CRESTVIEW, FL 32536-9359
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA017362
FL
Other
Enumeration date
12/18/2014
Last updated
12/18/2014
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