Healthcare Provider Details

I. General information

NPI: 1720043144
Provider Name (Legal Business Name): PHYSICALLY SPEAKING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10125 W COLONIAL DR SUITE 216
OCOEE FL
34761-4211
US

IV. Provider business mailing address

10125 W COLONIAL DR SUITE 216
OCOEE FL
34761-4211
US

V. Phone/Fax

Practice location:
  • Phone: 407-295-2956
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: THERESA B. DOURADO
Title or Position: PRESIDENT
Credential: PT
Phone: 407-295-2956