Healthcare Provider Details

I. General information

NPI: 1144773094
Provider Name (Legal Business Name): ADKORE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 UPSALA RD
SANFORD FL
32771-6668
US

IV. Provider business mailing address

1260 UPSALA RD
SANFORD FL
32771-6668
US

V. Phone/Fax

Practice location:
  • Phone: 407-328-7595
  • Fax: 800-398-5605
Mailing address:
  • Phone: 407-328-7595
  • Fax: 800-398-5605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISA AYALA
Title or Position: OWNER
Credential:
Phone: 407-328-7595