Healthcare Provider Details

I. General information

NPI: 1770817009
Provider Name (Legal Business Name): BRITT M VALLOT ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 09/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3403 TECHNOLOGICAL AVE
ORLANDO FL
32817-1476
US

IV. Provider business mailing address

2415 LAURA PL
ORLANDO FL
32803-3624
US

V. Phone/Fax

Practice location:
  • Phone: 407-681-2520
  • Fax:
Mailing address:
  • Phone: 504-952-2536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL2746
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: