Healthcare Provider Details

I. General information

NPI: 1508817537
Provider Name (Legal Business Name): PHYSIOTHERAPY PLUS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6388 SILVER STAR RD STE 1E
ORLANDO FL
32818-3235
US

IV. Provider business mailing address

6388 SILVER STAR RD 1E
ORLANDO FL
32818-3235
US

V. Phone/Fax

Practice location:
  • Phone: 321-369-9133
  • Fax: 888-696-1020
Mailing address:
  • Phone: 321-369-9133
  • Fax: 888-696-1020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 21887
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 32752
License Number StateFL

VIII. Authorized Official

Name: IDLER BONHOMME
Title or Position: CLINICAL DIR
Credential: LMT, MPT, DPT
Phone: 321-369-9133