1841538113 NPI number — BASE PHYSICAL THERAPY LLC

Table of content: (NPI 1841538113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841538113 NPI number — BASE PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BASE PHYSICAL THERAPY LLC
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:
1841538113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14344
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32317-4344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-727-5406
Provider Business Mailing Address Fax Number:
850-727-5764

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1989 CAPITAL CIR NE
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
TALLAHASSEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32308-4493
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-727-5406
Provider Business Practice Location Address Fax Number:
850-727-5764
Provider Enumeration Date:
01/22/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LARSON
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
850-508-7831

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 008869300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: Y90SZ . This is a "BCBSFL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 008869300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com