Healthcare Provider Details

I. General information

NPI: 1376640961
Provider Name (Legal Business Name): ALLY PHYSICAL THERAPY CENTERI INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10622 STRADFORD ROW
ORLANDO FL
32817-2041
US

IV. Provider business mailing address

10622 STRADFORD ROW
ORLANDO FL
32817-2041
US

V. Phone/Fax

Practice location:
  • Phone: 407-970-0907
  • Fax: 407-260-5411
Mailing address:
  • Phone: 407-970-0907
  • Fax: 407-260-5411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT 3746
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT3746
License Number StateFL

VIII. Authorized Official

Name: MRS. HILDA ANGELICA RIVERA-MEJIAS
Title or Position: DIRECTOR
Credential: PHYSICAL THERAPIST
Phone: 407-970-0907