1609810456 NPI number — CENTRAL FLORIDA THERAPY SOLUTIONS, INC

Table of content: (NPI 1609810456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609810456 NPI number — CENTRAL FLORIDA THERAPY SOLUTIONS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL FLORIDA THERAPY SOLUTIONS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609810456
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
455 W WARREN AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
LONGWOOD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32750-4002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-260-0551
Provider Business Mailing Address Fax Number:
407-265-9590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 W WARREN AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LONGWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32750-4002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-260-0551
Provider Business Practice Location Address Fax Number:
407-265-9590
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSTON
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
CLAUDIA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
407-260-0551

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X , with the licence number:  PT 3886 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X , with the licence number: OT 11334 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SA5296 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 28832 . This is a "WELL CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: X1601 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: Y921D . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 217278 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 886431400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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