Healthcare Provider Details

I. General information

NPI: 1710285325
Provider Name (Legal Business Name): CHARLES ROBERT HUFHAM PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2011
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 LEXINGTON GREEN LN
SANFORD FL
32771-1013
US

IV. Provider business mailing address

1230 S TIMBERLAND TRL
ALTAMONTE SPRINGS FL
32714-1298
US

V. Phone/Fax

Practice location:
  • Phone: 214-929-7299
  • Fax:
Mailing address:
  • Phone: 214-929-7299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA27337
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: