Healthcare Provider Details

I. General information

NPI: 1508003567
Provider Name (Legal Business Name): CASEY VAUGHN EBERLE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 WOODBURY RD STE 103104
ORLANDO FL
32828-4514
US

IV. Provider business mailing address

12163 WATER POPPY CT
ORLANDO FL
32828-5570
US

V. Phone/Fax

Practice location:
  • Phone: 407-373-6082
  • Fax: 407-373-6083
Mailing address:
  • Phone: 904-859-0478
  • Fax: 407-373-6083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number24520
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: