Individual
MR. PETER O'FALLON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC/LAT
Contact information
Practice address
4421 COMMONS DR E, SUITE-B 108, DESTIN, FL 32541-3484
(850) 460-2588
Mailing address
93 DUNE LAKES CIR, B106, SANTA ROSA BEACH, FL 32459-8393
(314) 952-7123
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL 4145
FL
Other
Enumeration date
07/19/2015
Last updated
07/19/2015
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