Provider Demographics
NPI:1154592046
Name:CENTRAL FLORIDA PHYSICAL THERAPY
Entity type:Organization
Organization Name:CENTRAL FLORIDA PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-925-3706
Mailing Address - Street 1:2911 RED BUG LAKE RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5929
Mailing Address - Country:US
Mailing Address - Phone:407-696-0241
Mailing Address - Fax:407-696-0325
Practice Address - Street 1:2911 RED BUG LAKE RD
Practice Address - Street 2:SUITE 400
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5929
Practice Address - Country:US
Practice Address - Phone:407-696-0241
Practice Address - Fax:407-696-0325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT2641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1741Medicare PIN