Healthcare Provider Details

I. General information

NPI: 1154263804
Provider Name (Legal Business Name): CARLY BIEMANN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2765 S BAY ST
EUSTIS FL
32726-6501
US

IV. Provider business mailing address

2765 S BAY ST
EUSTIS FL
32726-6501
US

V. Phone/Fax

Practice location:
  • Phone: 352-589-5595
  • Fax: 352-589-5747
Mailing address:
  • Phone: 352-589-5595
  • Fax: 352-589-5747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: