Healthcare Provider Details

I. General information

NPI: 1265250781
Provider Name (Legal Business Name): PHYSIOTHERAPY WORKS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4824 GRANDVIEW PKWY
DAVENPORT FL
33837-2301
US

IV. Provider business mailing address

PO BOX 4605
WINTER PARK FL
32793-4605
US

V. Phone/Fax

Practice location:
  • Phone: 863-808-1888
  • Fax: 863-808-1888
Mailing address:
  • Phone: 407-657-5029
  • Fax: 407-657-6320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ERIC S MASON
Title or Position: PRESIDENT
Credential: PT
Phone: 407-657-5029