Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | AL200 | FL |
NPI | 1346459880 |
---|---|
Provider Name | Larry E Mayol |
First Address | Largo, FL 33773-2942 |
Second Address | Largo, FL 33771-3959 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AL200 | FLORIDA ATHLETIC TRAINER (01) | FL |