Healthcare Provider Details

I. General information

NPI: 1992931745
Provider Name (Legal Business Name): CAROLINE DANIELA RADOSZ N.D.,P.T.,D.P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 OPP DR
FORT WALTON BEACH FL
32548-4493
US

IV. Provider business mailing address

600 OPP DR
FORT WALTON BEACH FL
32548-4493
US

V. Phone/Fax

Practice location:
  • Phone: 850-301-1935
  • Fax: 850-301-1937
Mailing address:
  • Phone: 850-301-1935
  • Fax: 850-301-1937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 29221
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: