Individual
MICHAEL ROY HUMPHREY II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1438 SW MAIN BLVD, LAKE CITY, FL 32025-1106
(386) 755-3164
Mailing address
632 SW LEGION DR, LAKE CITY, FL 32024-4072
(850) 661-4113
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 26311
FL
Other
Enumeration date
01/03/2016
Last updated
01/03/2016
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