MEDICARE: THERAFLEX LLC

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
1	225100000X	Physical Therapist	PT 22653	FL

General Provider Information

NPI Number	:	1487091252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAFLEX LLC

Provider Business Mailing Address
First Line	:	600 N HIGHWAY 27
Second Line	:	SUITE 5
City	:	MINNEOLA
State	:	FL
Zip	:	34715-6265
Country	:	US
Telephone Number	:	352-874-6562
Fax Number	:	352-678-3419

Provider Business Practice Location Address
First Line	:	600 N HIGHWAY 27
Second Line	:	SUITE 5
City	:	MINNEOLA
State	:	FL
Zip	:	34715-6265
Country	:	US
Telephone Number	:	352-874-6562
Fax Number	:	352-678-3419

Authorized Official
Title or Position	:	MANAGER
Name	:	HEATHER M VAZ-ANTROBUS
Credential	:	MPT
Telephone Number	:	352-874-6562

Provider Enumeration Date	:	06/03/2013
Last Update Date	:	01/04/2016

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Directions to “THERAFLEX LLC ” Practice Location

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