Individual
MATT LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1120 35TH AVE N, SAINT PETERSBURG, FL 33704-1853
(813) 508-3627
Mailing address
1120 35TH AVE N, SAINT PETERSBURG, FL 33704-1853
(813) 508-3627
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA21300
FL
Other
Enumeration date
02/12/2010
Last updated
02/12/2010
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