Healthcare Provider Details

I. General information

NPI: 1366437360
Provider Name (Legal Business Name): CENTRAL FLORIDA PHYSICAL MEDICINE AND REHABILITATION PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 01/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3261 US HIGHWAY 441/27 STE B2
FRUITLAND PARK FL
34731-4492
US

IV. Provider business mailing address

PO BOX 490216
LEESBURG FL
34749-0216
US

V. Phone/Fax

Practice location:
  • Phone: 352-365-9553
  • Fax: 352-365-0205
Mailing address:
  • Phone: 352-365-9553
  • Fax: 352-365-0205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: MRS. MARGARET A MAIELLO
Title or Position: ADMIN
Credential:
Phone: 352-365-9553