Healthcare Provider Details

I. General information

NPI: 1952829038
Provider Name (Legal Business Name): TODD BARRALL LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 09/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4042 ANDY PELLA DR
SPRING HILL FL
34606-4000
US

IV. Provider business mailing address

5227 FAIRHAVEN AVE
SPRING HILL FL
34608-2354
US

V. Phone/Fax

Practice location:
  • Phone: 352-835-7140
  • Fax:
Mailing address:
  • Phone: 352-428-2532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number45581
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: