MR. Peter O'fallon JR., ATC/LAT

NPI #1104200179 in Destin, Florida

Provider Information

NPI Number: 1104200179
Entity Type: Individual
Name: MR. Peter O'fallon JR., ATC/LAT
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Specialist/Technologist - Athletic Trainer
Credential: ATC/LAT
Enumeration Date: Jul 19, 2015
Last Updated: Jul 19, 2015

Practice Location

Address: 4421 COMMONS DR E
Address 2: SUITE-B 108
City: Destin
State: Florida
ZIP Code: 32541-3484
Phone: (850) 460-2588

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist/Technologist - Athletic Trainer — Athletic Trainer	2255A2300X	Primary

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