Healthcare Provider Details

I. General information

NPI: 1780652941
Provider Name (Legal Business Name): WHITE SANDS PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 OPP DRIVE
FT. WALTON BEACH FL
32548-4493
US

IV. Provider business mailing address

600 OPP DRIVE
FT. 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 Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number250750708034
License Number StateFL

VIII. Authorized Official

Name: ROBERT P MANN
Title or Position: DIRECTOR
Credential: PT OCS
Phone: 850-301-1935