1326854159 NPI number — TALLAHASSEE ORTHOPEDIC & SPORTS PHYSICAL THERAPY

Table of content: (NPI 1326854159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326854159 NPI number — TALLAHASSEE ORTHOPEDIC & SPORTS PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TALLAHASSEE ORTHOPEDIC & SPORTS PHYSICAL THERAPY
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:
1326854159
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1650 LYNDON FARM CT STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40223-5005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1431 OHIO AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVE OAK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32064-4817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-973-3316
Provider Business Practice Location Address Fax Number:
850-973-1261
Provider Enumeration Date:
12/06/2024

Additional Information

Authorized Official

Authorized Official Last Name:
KNISLEY
Authorized Official First Name:
KENT
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
850-545-5318

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PENDING , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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