Individual
DR. MARILYN ANITA VESTAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
13000 BRUCE B DOWNS BLVD, TAMPA, FL 33612-4745
(813) 972-2000
Mailing address
141 41ST AVE NE, ST PETERSBURG, FL 33703-5823
(863) 288-8688
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05262006
T'AI CHI CHIH FOUNDATION
—
Enumeration date
08/15/2019
Last updated
08/15/2019
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