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General NPI Number Information
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NPI Number | 1184123275
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Entity Type | Organization
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Legal Business Name | FIRST LINE PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 02/05/2018
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Last Update Date | 05/06/2020
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Provider Practice Location Address
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Address Line | 29446 TANSY PASS
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City | WESLEY CHAPEL
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State | FL
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Zip | 33543-6579
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Country | US
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Telephone | 727-364-1501
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Fax |
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Provider Business Mailing Address
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Address Line | 29446 TANSY PASS
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City | WESLEY CHAPEL
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State | FL
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Zip | 33543-6579
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Country | US
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Telephone | 813-399-3963
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Fax | 813-602-5524
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | RICHARD DOUGLAS JOHN
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Credential | PT, DPT
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Telephone | 727-364-1501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT28541
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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