Healthcare Provider Details

I. General information

NPI: 1124016175
Provider Name (Legal Business Name): CENTRAL ORTHOPEDICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E CENTRAL AVE
WINTER HAVEN FL
33880-6311
US

IV. Provider business mailing address

222 E CENTRAL AVE
WINTER HAVEN FL
33880-6311
US

V. Phone/Fax

Practice location:
  • Phone: 863-299-5667
  • Fax: 863-299-7722
Mailing address:
  • Phone: 863-299-5667
  • Fax: 863-299-7722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHERRI L KNEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 863-299-5667