Provider Demographics
NPI:1073943700
Name:ENCORE PREAKNESS, INC.
Entity type:Organization
Organization Name:ENCORE PREAKNESS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:E
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:727-510-3850
Mailing Address - Street 1:4025 TAMPA RD STE 1106
Mailing Address - Street 2:LEGAL/REGULATORY
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3213
Mailing Address - Country:US
Mailing Address - Phone:888-974-7878
Mailing Address - Fax:727-726-1825
Practice Address - Street 1:3500 OAK MANOR LN
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-1211
Practice Address - Country:US
Practice Address - Phone:727-581-9427
Practice Address - Fax:727-587-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHT770AMedicare PIN