Individual
MITCHELL REY TALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
419 WATERFORD ST, EDINBORO, PA 16412-5517
(814) 734-5021
Mailing address
419 WATERFORD ST, EDINBORO, PA 16412-5517
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
TEI003417
PA
Other
Enumeration date
01/06/2016
Last updated
01/06/2016
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