Provider Demographics
NPI:1346397882
Name:PROMEDICSHEALTH CORP LLC
Entity type:Organization
Organization Name:PROMEDICSHEALTH CORP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:NEESEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:407-772-4515
Mailing Address - Street 1:686 N HUNT CLUB BLVD STE 180
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-2218
Mailing Address - Country:US
Mailing Address - Phone:407-772-4515
Mailing Address - Fax:407-772-4518
Practice Address - Street 1:686 N HUNT CLUB BLVD STE 180
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-2218
Practice Address - Country:US
Practice Address - Phone:407-772-4515
Practice Address - Fax:407-772-4518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
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
FLK8611Medicare ID - Type Unspecified