Basic Information
| Provider Information | |||||||||
| NPI: | 1801401021 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORTHO FLORIDA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 751 PARK OF COMMERCE DR STE 112 | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334873622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613001792 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17425 7TH ST STE 560174 | ||||||||
| Address2: | |||||||||
| City: | MONTVERDE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347563206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0166407544 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2020 | ||||||||
| LastUpdateDate: | 09/14/2020 | ||||||||
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| AuthorizedOfficialLastName: | WEICHT | ||||||||
| AuthorizedOfficialFirstName: | ADRIANA | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 5613001792 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ORTHO FLORIDA, LLC | ||||||||
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| NPICertificationDate: | 09/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No ID Information.