Provider Demographics
NPI:1306624069
Name:HYDE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:HYDE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HYDE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:850-238-0650
Mailing Address - Street 1:323 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3230
Mailing Address - Country:US
Mailing Address - Phone:850-238-0552
Mailing Address - Fax:850-769-1166
Practice Address - Street 1:2250 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4548
Practice Address - Country:US
Practice Address - Phone:850-872-3715
Practice Address - Fax:850-769-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy