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General NPI Number Information
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NPI Number | 1356139000
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Entity Type | Organization
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Legal Business Name | ORTHO FLORIDA, LLC
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Dates
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Enumeration Date | 04/30/2025
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 1100 SW SAINT LUCIE WEST BLVD STE 105
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-1779
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Country | US
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Telephone | 561-202-8886
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 978766
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City | DALLAS
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State | TX
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Zip | 75397-8766
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OF CEO
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Name | DANE TRASK
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Credential |
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Telephone | 813-787-1128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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