Healthcare Provider Details

I. General information

NPI: 1548388804
Provider Name (Legal Business Name): RUFUS BOYKIN III PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12184 LAKE UNDERHILL RD
ORLANDO FL
32825-5012
US

IV. Provider business mailing address

4017 ANDOVER CAY BLVD
ORLANDO FL
32825-2704
US

V. Phone/Fax

Practice location:
  • Phone: 407-382-3777
  • Fax:
Mailing address:
  • Phone: 407-492-4525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT18262
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: