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Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MSPT

Contact information

Practice address
6030 6TH AVE, NEW PORT RICHEY, FL 34653-5157
(727) 271-1432
(727) 849-3899
Mailing address
6030 6TH AVE, NEW PORT RICHEY, FL 34653-5157
(727) 271-1432
(727) 849-3899

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT15071
FL

Other

Enumeration date
08/17/2014
Last updated
08/17/2014
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