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General NPI Number Information
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NPI Number | 1386895050
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Entity Type | Organization
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Legal Business Name | PRO-MOTION PHYSICAL THERAPY OF VOLUSIA CTY
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Dates
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Enumeration Date | 09/30/2008
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Last Update Date | 04/30/2015
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Provider Practice Location Address
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Address Line | 4606 S CLYDE MORRIS BLVD SUITE 1-D
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City | PORT ORANGE
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State | FL
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Zip | 32129-6404
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Country | US
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Telephone | 386-492-2986
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Fax | 386-492-2987
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Provider Business Mailing Address
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Address Line | PO BOX 290699
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City | PORT ORANGE
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State | FL
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Zip | 32129-0699
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Country | US
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Telephone | 386-492-2986
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Fax | 386-492-2987
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIE CARMEN YU
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Credential | P.T.
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Telephone | 386-492-2986
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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 | 7269
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License Number State | FL
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