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NPI Code Detail

MEDICARE: LARA HOOLEY PTA

MEDICARE: LARA HOOLEY PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant20776FL

General Provider Information

NPI Number : 1366810640
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARA HOOLEY PTA
Provider Business Mailing Address
First Line : 10416 HETRICK CIR W
Second Line :
City : LARGO
State : FL
Zip : 33774-5217
Country : US
Telephone Number : 727-460-1440
Fax Number :
Provider Business Practice Location Address
First Line : 5535 PARK ST N
Second Line :
City : ST PETERSBURG
State : FL
Zip : 33709-6309
Country : US
Telephone Number : 727-209-0579
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2015
Last Update Date : 09/03/2015

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