Basic Information
| Provider Information | |||||||||
| NPI: | 1972646719 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOFFITT | ||||||||
| FirstName: | CAROLE | ||||||||
| MiddleName: | MALLONEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5295 STARLINE DR | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347719030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077916943 | ||||||||
| FaxNumber: | 4079571706 | ||||||||
| Practice Location | |||||||||
| Address1: | 1361 E IRLO BRONSON MEMORIAL HWY | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347715823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079571454 | ||||||||
| FaxNumber: | 4079571706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT 3010 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.