Individual
MRS. VICKY JANE BAHMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
36915 PATTON RD, DADE CITY, FL 33523-1209
(352) 457-6640
Mailing address
36915 PATTON ROAD, DADE CITY, FL 33523
(352) 457-6640
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
19646
MA
208100000X
Physical Medicine & Rehabilitation Physician
CAPT38645
CA
208100000X
Physical Medicine & Rehabilitation Physician
Primary
FLPT15121
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
889589900
—
FL
Enumeration date
07/21/2011
Last updated
08/01/2012
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