Healthcare Provider Details

I. General information

NPI: 1831244631
Provider Name (Legal Business Name): QUALITY THERAPY & SENIORS FITNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 INNOVATION DR
SAINT CLOUD FL
34769-6501
US

IV. Provider business mailing address

3105 INNOVATION DR
SAINT CLOUD FL
34769-6501
US

V. Phone/Fax

Practice location:
  • Phone: 407-498-0539
  • Fax: 877-203-2038
Mailing address:
  • Phone: 407-498-0539
  • Fax: 877-203-2038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JULIUS CAESAR ORIAS LICONG
Title or Position: PT DIRECTOR-OWNER
Credential: PT, CSST,RN
Phone: 407-498-0539