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General NPI Number Information
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NPI Number | 1235324005
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Entity Type | Organization
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Legal Business Name | FAMILY PHYSICAL THERAPY CENTER
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 02/04/2008
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Provider Practice Location Address
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Address Line | 704 W LUMSDEN RD
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City | BRANDON
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State | FL
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Zip | 33511-6260
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Country | US
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Telephone | 813-654-3808
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Fax |
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Provider Business Mailing Address
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Address Line | 704 W LUMSDEN RD
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City | BRANDON
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State | FL
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Zip | 33511-6260
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Country | US
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Telephone | 813-654-3808
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JANIESSE O RIVERA
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Credential | P.T
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Telephone | 813-654-3808
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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 | PT0005096
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License Number State | FL
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