Healthcare Provider Details

I. General information

NPI: 1366294365
Provider Name (Legal Business Name): TALLAHASSEE ORTHOPEDIC CLINIC III, P.L.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 NW 4TH BLVD STE 90
GAINESVILLE FL
32607-1846
US

IV. Provider business mailing address

3334 CAPITAL MEDICAL BLVD STE 400
TALLAHASSEE FL
32308-4470
US

V. Phone/Fax

Practice location:
  • Phone: 352-647-9700
  • Fax:
Mailing address:
  • Phone: 850-877-8174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALLISON POWELL
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 850-877-8174