Basic Information
| Provider Information | |||||||||
| NPI: | 1538299052 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOFIELD | ||||||||
| FirstName: | BARBAREE | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2914 FOREST RESERVE PL | ||||||||
| Address2: | |||||||||
| City: | SEFFNER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335845780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8135717317 | ||||||||
| FaxNumber: | 8136552622 | ||||||||
| Practice Location | |||||||||
| Address1: | 6508 GUNN HWY | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336254022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139636923 | ||||||||
| FaxNumber: | 8662786878 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA18446 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.