Basic Information
| Provider Information | |||||||||
| NPI: | 1730211095 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSIOTHERAPY ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6651 VINELAND RD | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328197838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072263339 | ||||||||
| FaxNumber: | 4072263534 | ||||||||
| Practice Location | |||||||||
| Address1: | 6651 VINELAND RD | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328197838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072263339 | ||||||||
| FaxNumber: | 4072263534 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SPECHT | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
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| AuthorizedOfficialTitleorPosition: | GROUP DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4072263339 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | PT20384 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.