Healthcare Provider Details

I. General information

NPI: 1174762207
Provider Name (Legal Business Name): PHYSIORX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2706 REW CIR SUITE 400
OCOEE FL
34761-4215
US

IV. Provider business mailing address

2706 REW CIR
OCOEE FL
34761-4215
US

V. Phone/Fax

Practice location:
  • Phone: 407-718-5549
  • Fax: 407-264-8969
Mailing address:
  • Phone: 407-718-5549
  • Fax: 407-264-8969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 8093
License Number StateFL

VIII. Authorized Official

Name: DENISE MASSON
Title or Position: MANAGER
Credential: P.T.
Phone: 407-718-5549