Healthcare Provider Details

I. General information

NPI: 1356469514
Provider Name (Legal Business Name): TALLAHASSEE PHYSICAL THERAPY AND REHABILITATION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 SALEM CT
TALLAHASSEE FL
32301-2810
US

IV. Provider business mailing address

1 EAGLES WAY STE 333
CARRABELLE FL
32322-8020
US

V. Phone/Fax

Practice location:
  • Phone: 850-877-8177
  • Fax: 850-942-0128
Mailing address:
  • Phone: 850-519-4966
  • Fax: 850-942-0128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. BERT B BOLDT II
Title or Position: AUTHORIZED OFFICIAL/OWNER
Credential: P.T.
Phone: 850-519-4966