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General NPI Number Information
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NPI Number | 1346459880
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Entity Type | Individual
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Provider Name | LARRY E MAYOL ATC
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Gender | Male
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8151 ULMERTON RD
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City | LARGO
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State | FL
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Zip | 33771-3959
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Country | US
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Telephone | 727-539-6764
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Fax | 727-530-0125
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Provider Business Mailing Address
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Address Line | 8193 PERTH DR
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City | LARGO
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State | FL
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Zip | 33773-2942
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Country | US
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Telephone | 727-430-4724
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Fax | 727-530-0125
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | AL200
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License Number State | FL
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