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General NPI Number Information
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NPI Number | 1093309270
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Entity Type | Individual
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Provider Name | GLENDA ALICIA KIZILTAN PTA
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Gender | Female
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Dates
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Enumeration Date | 02/27/2021
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Last Update Date | 02/27/2021
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Provider Practice Location Address
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Address Line | 13550 S JOG RD # 100
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City | DELRAY BEACH
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State | FL
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Zip | 33446-3808
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Country | US
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Telephone | 561-300-1999
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Fax |
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Provider Business Mailing Address
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Address Line | 5820 W SAMPLE RD APT 205
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-3240
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Country | US
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Telephone | 954-646-4947
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA30852
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License Number State | FL
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