Provider Demographics
NPI:1346459880
Name:MAYOL, LARRY E (ATC)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:E
Last Name:MAYOL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8193 PERTH DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-2942
Mailing Address - Country:US
Mailing Address - Phone:727-430-4724
Mailing Address - Fax:727-530-0125
Practice Address - Street 1:8151 ULMERTON RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3959
Practice Address - Country:US
Practice Address - Phone:727-539-6764
Practice Address - Fax:727-530-0125
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL2002251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL200OtherFLORIDA ATHLETIC TRAINER