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Individual

MR. ROMAN CHANCE FOX

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RECREATION THERAPIST

Contact information

Practice address
17502 FALLOWFIELD DR, LUTZ, FL 33549-5584
(757) 333-1112
Mailing address
16727 CARACARA CT, SPRING HILL, FL 34610-9011
(757) 333-1112

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
PTA 26297
FL
225800000X
Recreation Therapist
Primary

Other

Enumeration date
12/09/2016
Last updated
11/24/2021
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