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General NPI Number Information
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NPI Number | 1629716840
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Entity Type | Individual
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Provider Name | MAKYLA DANNIELL HARRISON PTA
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Gender | Female
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Dates
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Enumeration Date | 05/26/2022
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Last Update Date | 05/26/2022
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Provider Practice Location Address
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Address Line | 10800 TEMPLE TER
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City | SEMINOLE
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State | FL
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Zip | 33772-4736
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Country | US
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Telephone | 727-547-3315
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Fax |
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Provider Business Mailing Address
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Address Line | 11114 101ST AVE
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City | SEMINOLE
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State | FL
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Zip | 33772-2409
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Country | US
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Telephone | 319-651-5295
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 30629
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License Number State | FL
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