Provider Demographics
NPI:1316970056
Name:FREEDOM PHYSICAL THERAPY
Entity type:Organization
Organization Name:FREEDOM PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUPA
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:941-474-0419
Mailing Address - Street 1:579 S INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-3751
Mailing Address - Country:US
Mailing Address - Phone:941-474-0419
Mailing Address - Fax:941-474-0547
Practice Address - Street 1:579 S INDIANA AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-3751
Practice Address - Country:US
Practice Address - Phone:941-474-0419
Practice Address - Fax:941-474-0547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4346Medicare ID - Type UnspecifiedMEDICARE NUMBER