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NPI Code Detail

MEDICARE: ENCORE PREAKNESS, INC.

MEDICARE: ENCORE PREAKNESS, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2000XPhysical Therapy Clinic/Center

General Provider Information

NPI Number : 1295860138
Entity Type Code : Organization
Provider Name (Legal Business Name) : ENCORE PREAKNESS, INC.
Provider Business Mailing Address
First Line : 4025 TAMPA RD STE 1106
Second Line : LEGAL DEPARTMENT
City : OLDSMAR
State : FL
Zip : 34677-3213
Country : US
Telephone Number : 888-974-7878
Fax Number : 727-726-1825
Provider Business Practice Location Address
First Line : 2255 MONARCH DR
Second Line :
City : NAPERVILLE
State : IL
Zip : 60563-4164
Country : US
Telephone Number : 630-300-1272
Fax Number :
Authorized Official
Title or Position : VICE PRESIDENT
Name : SUE E. OLSEN
Credential : CCC-SLP
Telephone Number : 727-510-3850
Provider Enumeration Date : 02/22/2007
Last Update Date : 04/22/2016

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