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NPI Code Detail

MEDICARE: MRS. LAURA BRIMHALL BUSCHLE PTA

MEDICARE:  MRS. LAURA BRIMHALL BUSCHLE  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 AssistantPTA18614FL

General Provider Information

NPI Number : 1699814517
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAURA BRIMHALL BUSCHLE PTA
Provider Business Mailing Address
First Line : 7687 PLANTATION BAY DR E
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32244-5182
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6248 103RD ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32210-7733
Country : US
Telephone Number : 904-573-0046
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. LAURA BRIMHALL BUSCHLE PTA” Practice Location

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