Healthcare Provider Details

I. General information

NPI: 1285767228
Provider Name (Legal Business Name): PHYSIOTHERAPY WORKS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 STATE ROAD 436 SUITE 1000
WINTER PARK FL
32792
US

IV. Provider business mailing address

PO BOX 4605
WINTER PARK FL
32793-4605
US

V. Phone/Fax

Practice location:
  • Phone: 407-657-5029
  • Fax: 407-657-6320
Mailing address:
  • Phone: 407-657-5029
  • Fax: 407-657-6320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMM15854
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC SAMUEL MASON
Title or Position: PRESIDENT
Credential: P.T.
Phone: 407-657-5029