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General NPI Number Information
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NPI Number | 1609063494
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Entity Type | Individual
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Provider Name | STUART W MACCOLLOM PT
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Gender | Male
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 03/02/2018
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Provider Practice Location Address
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Address Line | 8140 BAYHAVEN DR
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City | SEMINOLE
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State | FL
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Zip | 33776-3321
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Country | US
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Telephone | 727-546-8900
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Fax | 727-546-8940
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Provider Business Mailing Address
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Address Line | 8140 BAYHAVEN DR
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City | SEMINOLE
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State | FL
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Zip | 33776-3321
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Country | US
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Telephone | 727-546-8900
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Fax | 727-546-8940
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT2912
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License Number State | FL
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