Healthcare Provider Details

I. General information

NPI: 1841631553
Provider Name (Legal Business Name): MINDY ERIN HUTFILZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5535 S WILLIAMSON BLVD STE 774
PORT ORANGE FL
32128-8311
US

IV. Provider business mailing address

965 MANOR LN UNIT S
COLUMBUS OH
43221-2424
US

V. Phone/Fax

Practice location:
  • Phone: 800-330-7711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305208039
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: