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General NPI Number Information
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NPI Number | 1235183021
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Entity Type | Organization
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Legal Business Name | LEGACY HEALTHCARE INC
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 08/17/2015
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Provider Practice Location Address
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Address Line | 4134 GULF OF MEXICO DR SUITE 209
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City | LONGBOAT KEY
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State | FL
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Zip | 34228-2612
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Country | US
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Telephone | 941-383-0414
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Fax | 941-383-0120
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Provider Business Mailing Address
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Address Line | PO BOX 1156
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City | ELLENTON
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State | FL
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Zip | 34222-1156
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Country | US
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Telephone | 941-729-0003
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Fax | 941-729-0004
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. CESAR CHACON
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Credential |
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Telephone | 941-302-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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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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