Healthcare Provider Details

I. General information

NPI: 1528114659
Provider Name (Legal Business Name): EXOS - ATHLETES' PERFORMANCE FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 GULF BREEZE PKWY
GULF BREEZE FL
32561-4838
US

IV. Provider business mailing address

1040 GULF BREEZE PKWY
GULF BREEZE FL
32561-4838
US

V. Phone/Fax

Practice location:
  • Phone: 850-916-8650
  • Fax: 850-916-8709
Mailing address:
  • Phone: 850-916-8650
  • Fax: 850-916-8709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHERI WALTERS
Title or Position: DIRECTOR, PHYSICAL THERAPY
Credential: PT
Phone: 214-618-3246