Healthcare Provider Details

I. General information

NPI: 1568308419
Provider Name (Legal Business Name): ORTHO VIP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 MAITLAND AVE
ALTAMONTE SPRINGS FL
32701-6834
US

IV. Provider business mailing address

628 MAITLAND AVE
ALTAMONTE SPRINGS FL
32701-6834
US

V. Phone/Fax

Practice location:
  • Phone: 321-972-2932
  • Fax: 321-972-2982
Mailing address:
  • Phone: 321-972-2932
  • Fax: 321-972-2982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. LEAH BOYD
Title or Position: PRACTICE MANAGER/CEO
Credential:
Phone: 407-764-0771