Individual
MR. MARK ROLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
18480 COCHRAN BLVD, PORT CHARLOTTE, FL 33948-3379
(941) 743-4700
Mailing address
1234 DESMOND ST, PORT CHARLOTTE, FL 33952-2810
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 24227
FL
Other
Enumeration date
10/03/2013
Last updated
10/03/2013
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