Healthcare Provider Details

I. General information

NPI: 1477214344
Provider Name (Legal Business Name): RONDA LYNN DRISKELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 N LECANTO HWY
BEVERLY HILLS FL
34465-3548
US

IV. Provider business mailing address

3400 N LECANTO HWY
BEVERLY HILLS FL
34465-3548
US

V. Phone/Fax

Practice location:
  • Phone: 352-527-8489
  • Fax:
Mailing address:
  • Phone: 352-527-8489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA19642
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: