Healthcare Provider Details

I. General information

NPI: 1548500960
Provider Name (Legal Business Name): PT SOLUTIONS OF PENSACOLA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4338 GULF BREEZE PKWY
GULF BREEZE FL
32563-9149
US

IV. Provider business mailing address

PO BOX 240188
MONTGOMERY AL
36124-0188
US

V. Phone/Fax

Practice location:
  • Phone: 850-912-6840
  • Fax:
Mailing address:
  • Phone: 334-396-3273
  • Fax: 334-396-4905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MICHAEL S DEMAHY
Title or Position: CLINIC DIRECTOR
Credential: PT
Phone: 850-912-6840