Healthcare Provider Details

I. General information

NPI: 1184123275
Provider Name (Legal Business Name): FIRST LINE PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29446 TANSY PASS
WESLEY CHAPEL FL
33543-6579
US

IV. Provider business mailing address

29446 TANSY PASS
WESLEY CHAPEL FL
33543-6579
US

V. Phone/Fax

Practice location:
  • Phone: 727-364-1501
  • Fax:
Mailing address:
  • Phone: 813-399-3963
  • Fax: 813-602-5524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT28541
License Number StateFL

VIII. Authorized Official

Name: RICHARD DOUGLAS JOHN
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: PT, DPT
Phone: 727-364-1501