Healthcare Provider Details

I. General information

NPI: 1417775529
Provider Name (Legal Business Name): CALYX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1533 TAWNYBERRY CT
TRINITY FL
34655-5351
US

IV. Provider business mailing address

1533 TAWNYBERRY CT
TRINITY FL
34655-5351
US

V. Phone/Fax

Practice location:
  • Phone: 727-237-1403
  • Fax:
Mailing address:
  • Phone: 727-237-1403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL KRYDER
Title or Position: OWNER
Credential:
Phone: 727-237-1403