Individual
MRS. EVELYN GIL MACK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
CTRS
Contact information
Practice address
13000 BRUCE B DOWNS BLVD, RT117, TAMPA, FL 33612-4745
(813) 972-2000
(813) 978-5852
Mailing address
4124 IMPERIAL EAGLE DR, VALRICO, FL 33594-3965
(813) 661-4358
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39257
NATIONAL CERTIFICATION
—
Enumeration date
06/01/2006
Last updated
07/08/2007
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