Basic Information
| Provider Information | |||||||||
| NPI: | 1265657555 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ADVANCED PHYSICAL THERAPY OF CENTRAL FLORIDA INC | ||||||||
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| OtherOrganizationName: | HOUSECALLS THERAPY SERVICES, INC. | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 303 SE 17TH ST | ||||||||
| Address2: | #309-217 | ||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344714467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526933378 | ||||||||
| FaxNumber: | 8887589645 | ||||||||
| Practice Location | |||||||||
| Address1: | 5036 SE 110TH ST | ||||||||
| Address2: | |||||||||
| City: | BELLEVIEW | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344203759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526933378 | ||||||||
| FaxNumber: | 8887589645 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2007 | ||||||||
| LastUpdateDate: | 09/16/2009 | ||||||||
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| AuthorizedOfficialLastName: | HAMMOND | ||||||||
| AuthorizedOfficialFirstName: | LESTER | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3526933378 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT18770 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | AG560 | 01 | FL | MEDICARE PART B | OTHER |