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General NPI Number Information
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NPI Number | 1972874592
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Entity Type | Individual
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Provider Name | JOSEPH K MAMPALLIL RPT
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Gender | Male
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Dates
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Enumeration Date | 01/13/2012
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 1465 OAKFIELD DR
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City | BRANDON
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State | FL
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Zip | 33511-4854
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Country | US
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Telephone | 813-655-0404
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Fax |
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Provider Business Mailing Address
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Address Line | 1422 LAKE SHORE RANCH DR
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City | SEFFNER
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State | FL
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Zip | 33584-5562
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Country | US
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Telephone | 813-684-9618
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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 | PT21124
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License Number State | FL
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