Healthcare Provider Details

I. General information

NPI: 1538265152
Provider Name (Legal Business Name): THOMAS CENTER FOR PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 W INTERNATIONAL SPEEDWAY BLVD SUITE 110
DAYTONA BEACH FL
32114-8145
US

IV. Provider business mailing address

2570 W INTERNATIONAL SPEEDWAY BLVD SUITE 110
DAYTONA BEACH FL
32114-8145
US

V. Phone/Fax

Practice location:
  • Phone: 386-257-2672
  • Fax: 386-252-1005
Mailing address:
  • Phone: 386-257-2672
  • Fax: 386-252-1005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: TINAMARIE SCHULTZ
Title or Position: BUSINESS MANAGER
Credential:
Phone: 386-257-2672