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General NPI Number Information
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NPI Number | 1225347628
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Entity Type | Organization
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Legal Business Name | COMMUNITY CHOICE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 10/02/2010
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Last Update Date | 01/27/2011
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Provider Practice Location Address
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Address Line | 2500 W LAKE MARY BLVD SUITE 108
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City | LAKE MARY
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State | FL
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Zip | 32746-3501
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Country | US
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Telephone | 407-574-3181
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Fax |
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Provider Business Mailing Address
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Address Line | 3710 SAN JACINTO CIR
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City | SANFORD
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State | FL
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Zip | 32771-6124
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Country | US
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Telephone | 407-574-3181
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | EDWIN JUSTE
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Credential | D.C
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Telephone | 407-574-3181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 22714
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License Number State | FL
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