Provider Demographics
NPI:1770817009
Name:VALLOT, BRITT M (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:BRITT
Middle Name:M
Last Name:VALLOT
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 LAURA PL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3624
Mailing Address - Country:US
Mailing Address - Phone:504-952-2536
Mailing Address - Fax:
Practice Address - Street 1:3403 TECHNOLOGICAL AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-1476
Practice Address - Country:US
Practice Address - Phone:407-681-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL27462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer