Healthcare Provider Details

I. General information

NPI: 1467624874
Provider Name (Legal Business Name): FREE MOTION PHYSICAL THERAPY OF BREVARD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1982 ROCKLEDGE BLVD STE 102
ROCKLEDGE FL
32955-3723
US

IV. Provider business mailing address

1300 BEDFORD DR STE 105
MELBOURNE FL
32940-1991
US

V. Phone/Fax

Practice location:
  • Phone: 321-631-5366
  • Fax: 321-631-5365
Mailing address:
  • Phone: 321-242-7575
  • Fax: 321-242-7002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT231
License Number StateFL

VIII. Authorized Official

Name: ANTHONY ROBERT RAZZINO
Title or Position: CLINICAL DIRECTOR/OWNER
Credential: MSPT
Phone: 321-242-7575