Provider Demographics
NPI:1639302672
Name:BOURSIQUOT, DORCA (PTA)
Entity Type:Individual
Prefix:
First Name:DORCA
Middle Name:
Last Name:BOURSIQUOT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18001 OLD CUTLER RD
Mailing Address - Street 2:SUITE 354
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6422
Mailing Address - Country:US
Mailing Address - Phone:305-251-7477
Mailing Address - Fax:305-251-7475
Practice Address - Street 1:18001 OLD CUTLER RD
Practice Address - Street 2:SUITE 354
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6422
Practice Address - Country:US
Practice Address - Phone:305-251-7477
Practice Address - Fax:305-251-7475
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA20451225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant