Provider Demographics
NPI:1598270407
Name:TOTAL THERAPY FLORIDA, LLC
Entity type:Organization
Organization Name:TOTAL THERAPY FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:STIVER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:941-468-7202
Mailing Address - Street 1:3650 N ACCESS RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34224-8655
Mailing Address - Country:US
Mailing Address - Phone:941-460-3831
Mailing Address - Fax:941-218-5627
Practice Address - Street 1:1499 E VENICE AVE UNIT A
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-3207
Practice Address - Country:US
Practice Address - Phone:941-451-8657
Practice Address - Fax:941-218-5630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-14
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT31147OtherLICENSE