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General NPI Number Information
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NPI Number | 1952947525
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Entity Type | Individual
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Provider Name | HAYES MONICA BOLOFER MCCARROLL
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Gender | Female
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Dates
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Enumeration Date | 11/19/2019
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Last Update Date | 11/19/2019
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Provider Practice Location Address
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Address Line | 7101 MARTIN LUTHER KING ST N
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City | ST PETERSBURG
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State | FL
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Zip | 33702-5819
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Country | US
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Telephone | 217-737-1115
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Fax |
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Provider Business Mailing Address
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Address Line | 7701 BIDDULPH RD
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City | BROOKLYN
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State | OH
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Zip | 44144-3208
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Country | US
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Telephone | 216-854-1207
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT35372
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License Number State | FL
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