Healthcare Provider Details

I. General information

NPI: 1134394257
Provider Name (Legal Business Name): RL THERAPY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16322 OFFENHAUR RD
ODESSA FL
33556-2328
US

IV. Provider business mailing address

16322 OFFENHAUR ROAD
ODESSA FL
33556
US

V. Phone/Fax

Practice location:
  • Phone: 727-458-3667
  • Fax: 813-920-8596
Mailing address:
  • Phone: 727-458-3667
  • Fax: 813-920-8596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 7375
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 6632
License Number StateFL

VIII. Authorized Official

Name: RANDALL CHARLES DEAN
Title or Position: PRES
Credential:
Phone: 727-458-3667