Healthcare Provider Details

I. General information

NPI: 1154069276
Provider Name (Legal Business Name): CEDAR MOUNTAIN CHARTERED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2022
Last Update Date: 05/27/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 CORTARO DR
SUN CITY CENTER FL
33573-6811
US

IV. Provider business mailing address

APOLLO PAIN MANAGEMENT 720 CORTARO DR
SUN CITY FL
33573
US

V. Phone/Fax

Practice location:
  • Phone: 347-610-1688
  • Fax:
Mailing address:
  • Phone: 347-610-1688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT KORODY
Title or Position: PRESIDENT
Credential: MS PT LAC
Phone: 347-610-1688