Healthcare Provider Details

I. General information

NPI: 1235324005
Provider Name (Legal Business Name): FAMILY PHYSICAL THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 W LUMSDEN RD
BRANDON FL
33511-6260
US

IV. Provider business mailing address

704 W LUMSDEN RD
BRANDON FL
33511-6260
US

V. Phone/Fax

Practice location:
  • Phone: 813-654-3808
  • Fax:
Mailing address:
  • Phone: 813-654-3808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT0005096
License Number StateFL

VIII. Authorized Official

Name: JANIESSE O RIVERA
Title or Position: PRESIDENT
Credential: P.T
Phone: 813-654-3808