Healthcare Provider Details

I. General information

NPI: 1215017512
Provider Name (Legal Business Name): CENTRAL FLORIDA DREAMPLEX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S HIGHWAY 27 SUITE B201
CLERMONT FL
34711-6816
US

IV. Provider business mailing address

PO BOX 120547
CLERMONT FL
34712-0547
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-0212
  • Fax: 352-241-6361
Mailing address:
  • Phone: 352-394-0212
  • Fax: 352-241-6361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: AMY GOMES
Title or Position: PRESIDENT
Credential:
Phone: 352-394-0212