MEDICARE: PURSUIT INTEGRATIVE PAIN AND ADVANCED THERAPEUTICS PLLC

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

General Provider Information

NPI Number	:	1760210652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURSUIT INTEGRATIVE PAIN AND ADVANCED THERAPEUTICS PLLC

Provider Business Mailing Address
First Line	:	1004 DELRIDGE AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-3548
Country	:	US
Telephone Number	:	407-494-8835
Fax Number	:

Provider Business Practice Location Address
First Line	:	1004 DELRIDGE AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-3548
Country	:	US
Telephone Number	:	407-494-8835
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DPT
Name	:	RONALD MILLER
Credential	:
Telephone Number	:	407-495-8761

Provider Enumeration Date	:	07/23/2024
Last Update Date	:	07/23/2024

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Directions to “PURSUIT INTEGRATIVE PAIN AND ADVANCED THERAPEUTICS PLLC ” Practice Location

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