Healthcare Provider Details

I. General information

NPI: 1417470972
Provider Name (Legal Business Name): PRZEMYSLAW TOKARSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 08/05/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 OLD VINELAND RD STE 2501
KISSIMMEE FL
34746-5839
US

IV. Provider business mailing address

PO BOX 471086
KISSIMMEE FL
34747-9086
US

V. Phone/Fax

Practice location:
  • Phone: 248-977-9677
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT32479
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: