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General NPI Number Information
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NPI Number | 1225799919
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Entity Type | Individual
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Provider Name | EMILY FUKS PTA
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Gender | Female
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Dates
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Enumeration Date | 01/04/2022
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 2040 SHORT AVE
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City | ODESSA
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State | FL
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Zip | 33556-3445
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Country | US
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Telephone | 727-807-3101
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Fax |
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Provider Business Mailing Address
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Address Line | 1946 OAK ST
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City | CLEARWATER
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State | FL
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Zip | 33760-1701
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Country | US
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Telephone | 727-515-3988
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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 | PTA25034
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License Number State | FL
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