Healthcare Provider Details

I. General information

NPI: 1619318649
Provider Name (Legal Business Name): ERGO SMARTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2013
Last Update Date: 07/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9433 TRUMPET VINE LOOP
TRINITY FL
34655-5366
US

IV. Provider business mailing address

9433 TRUMPET VINE LOOP
TRINITY FL
34655-5366
US

V. Phone/Fax

Practice location:
  • Phone: 678-457-5630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LINDA LANGE
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 678-457-5630