1245340017 NPI number — OP THERAPY FL INC

Table of content: (NPI 1245340017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245340017 NPI number — OP THERAPY FL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OP THERAPY FL 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:
6
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:
1245340017
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2111 GLENWOOD DR
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
WINTER PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32792-3328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-644-9065
Provider Business Mailing Address Fax Number:
407-628-2792

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8132 HUDSON AVE
Provider Second Line Business Practice Location Address:
TANDEM HEALTH CARE OF BAYONET POINT INC
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34667-8571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-863-3100
Provider Business Practice Location Address Fax Number:
727-862-8913
Provider Enumeration Date:
08/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CONTE
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
407-571-1550

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  SNF10140961 , 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)