=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114558533
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESULTS THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2020
-----------------------------------------------------
Last Update Date | 02/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1221 E TARPON AVE
-----------------------------------------------------
City | TARPON SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34689-5441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-224-5121
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4103 HERITAGE LAKE CT
-----------------------------------------------------
City | LUTZ
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33558-9725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-638-3752
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. KANDIS A FERNANDEZ
-----------------------------------------------------
Credential | PTA
-----------------------------------------------------
Telephone | 787-224-5121
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------