Healthcare Provider Details

I. General information

NPI: 1306305172
Provider Name (Legal Business Name): JOSEPH MICHAEL TRUNCALE PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7045 EVERGREEN WOODS TRL
SPRING HILL FL
34608-1306
US

IV. Provider business mailing address

3489 AMBASSADOR AVE
SPRING HILL FL
34609-3008
US

V. Phone/Fax

Practice location:
  • Phone: 352-596-8371
  • Fax:
Mailing address:
  • Phone: 516-582-9112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA29267
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: