Healthcare Provider Details

I. General information

NPI: 1285495838
Provider Name (Legal Business Name): AGE STRONG PHYSICAL THERAPY AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4214 SOLUTIONS LN UNIT 103
BRADENTON FL
34211-4931
US

IV. Provider business mailing address

12819 24TH STREET CIR E
PARRISH FL
34219-6944
US

V. Phone/Fax

Practice location:
  • Phone: 941-348-6841
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MONICA NICHOL REID
Title or Position: OWNER
Credential: PT
Phone: 941-812-4448