Healthcare Provider Details

I. General information

NPI: 1649524810
Provider Name (Legal Business Name): BRITTANY MCCALL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2012
Last Update Date: 11/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1554 S WATER ST
STARKE FL
32091-4511
US

IV. Provider business mailing address

PO BOX 1099
MELROSE FL
32666-1099
US

V. Phone/Fax

Practice location:
  • Phone: 904-964-2208
  • Fax: 904-966-2203
Mailing address:
  • Phone: 352-475-3113
  • Fax: 352-475-5796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA22447
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: