Healthcare Provider Details

I. General information

NPI: 1356007512
Provider Name (Legal Business Name): WINTER PARK PHYSIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N LAKEMONT AVE
WINTER PARK FL
32792-3273
US

IV. Provider business mailing address

5415 LAKE HOWELL RD STE 118
WINTER PARK FL
32792-1033
US

V. Phone/Fax

Practice location:
  • Phone: 407-388-8801
  • Fax:
Mailing address:
  • Phone: 407-388-8801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: LI LIU
Title or Position: OWNER
Credential:
Phone: 407-388-8801