Healthcare Provider Details

I. General information

NPI: 1891396131
Provider Name (Legal Business Name): WHIPLASHMD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 CENTRE CIR STE 1018
ALTAMONTE SPRINGS FL
32714-7242
US

IV. Provider business mailing address

940 CENTRE CIR STE 1018
ALTAMONTE SPRINGS FL
32714-7242
US

V. Phone/Fax

Practice location:
  • Phone: 888-794-4752
  • Fax: 855-927-5078
Mailing address:
  • Phone: 888-794-4752
  • Fax: 407-789-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. LEONARD A. ROLLMAN
Title or Position: CLINIC DIRECTOR
Credential: DC
Phone: 888-794-4752