Individual
AUTUM BLAIR DENMARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.A.
Contact information
Practice address
404 NW HALL OF FAME DR, LAKE CITY, FL 32055-4833
(386) 755-3164
(386) 755-3165
Mailing address
404 NW HALL OF FAME DR, LAKE CITY, FL 32055-4833
(386) 755-3164
(386) 755-3165
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA23022
FL
Other
Enumeration date
01/03/2012
Last updated
01/03/2012
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