Individual provider · Type 1 NPI
Diana Ickes, PTA
Other Specialist/Technologist · Riverview, FL
NPI number
1669923496
Active
Practice location
11458 Captiva Kay Dr
Riverview, FL 33569-2057
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Other Specialist/Technologist Primary | 246Z00000X | PTA17336 (FL) |
Other Specialist/Technologist: General classification identifying individuals trained on specific equipment and technical procedures in one of a collection of miscellaneous healthcare disciplines.
About NPI 1669923496
Diana Ickes, PTA's National Provider Identifier is 1669923496, issued on Oct 17, 2016. The primary taxonomy on file is Other Specialist/Technologist (246Z00000X), and the practice location is in Riverview, FL. The record was last updated on Oct 17, 2016.