Healthcare Provider Details

I. General information

NPI: 1699211649
Provider Name (Legal Business Name): ADVANCED PHYSICAL THERAPY OF CENTRAL FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2017
Last Update Date: 01/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2953 TRAVERSE TRL
THE VILLAGES FL
32163-2017
US

IV. Provider business mailing address

1202 SW 17TH ST BOX 209-229
OCALA FL
34471-1231
US

V. Phone/Fax

Practice location:
  • Phone: 352-693-3378
  • Fax:
Mailing address:
  • Phone: 352-693-3378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: PHYLLIS RUSSELL
Title or Position: PCC TEAM LEADER
Credential:
Phone: 352-693-3378