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General NPI Number Information
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NPI Number | 1336680222
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Entity Type | Organization
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Legal Business Name | AGILE PHYSICAL THERAPY & WELLNESS CENTER LLC
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 06/23/2017
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Provider Practice Location Address
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Address Line | 6735 CONROY WINDERMERE RD, SUITE 223
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City | ORLANDO
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State | FL
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Zip | 32835
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Country | US
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Telephone | 248-982-8088
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Fax |
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Provider Business Mailing Address
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Address Line | 6735 CONROY WINDERMERE RD, SUITE 223
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City | ORLANDO
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State | FL
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Zip | 32835
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Country | US
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Telephone | 248-982-8088
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MR. NIRAV ANILKUMAR SHAH
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Credential | PT, DPT
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Telephone | 248-982-8088
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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 | 29973
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License Number State | FL
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