Healthcare Provider Details

I. General information

NPI: 1821620170
Provider Name (Legal Business Name): FYZIOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 WILSHIRE BLVD
CASSELBERRY FL
32707-5352
US

IV. Provider business mailing address

174 WILSHIRE BLVD
CASSELBERRY FL
32707-5352
US

V. Phone/Fax

Practice location:
  • Phone: 407-288-8299
  • Fax:
Mailing address:
  • Phone: 407-288-8299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL LAVARIAS
Title or Position: ADMINISTRATOR
Credential: PT
Phone: 386-214-8886