Healthcare Provider Details

I. General information

NPI: 1568601862
Provider Name (Legal Business Name): THE CENTER FOR BONE AND JOINT DISEASE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7544 JACQUE RD
HUDSON FL
34667
US

IV. Provider business mailing address

PO BOX 628213
ORLANDO FL
32862-8213
US

V. Phone/Fax

Practice location:
  • Phone: 727-697-2200
  • Fax:
Mailing address:
  • Phone: 727-697-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MS. GRACE COLLAR
Title or Position: OFFICE MANAGER
Credential:
Phone: 727-697-2200