Healthcare Provider Details

I. General information

NPI: 1073508859
Provider Name (Legal Business Name): STANLEY PYFROM PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 S HOWARD AVE
TAMPA FL
33606-2413
US

IV. Provider business mailing address

602 S HOWARD AVE
TAMPA FL
33606-2413
US

V. Phone/Fax

Practice location:
  • Phone: 813-253-2406
  • Fax: 813-251-4290
Mailing address:
  • Phone: 813-253-2406
  • Fax: 813-251-4290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA526
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL 307
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: