Healthcare Provider Details

I. General information

NPI: 1316482110
Provider Name (Legal Business Name): ORTHO FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 N FEDERAL HWY STE 102
FT LAUDERDALE FL
33308-3201
US

IV. Provider business mailing address

751 PARK OF COMMERCE DR STE 112
BOCA RATON FL
33487-3626
US

V. Phone/Fax

Practice location:
  • Phone: 954-866-9699
  • Fax:
Mailing address:
  • Phone: 561-447-0361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DANE TRASK
Title or Position: COO
Credential:
Phone: 813-787-1128