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General NPI Number Information
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NPI Number | 1437357811
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Entity Type | Organization
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Legal Business Name | ORTHOPEDIC & SPORTS PHYSICAL THERAPY CENTER LLC
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Dates
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Enumeration Date | 07/06/2007
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Last Update Date | 04/28/2016
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Provider Practice Location Address
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Address Line | 86 LYNN DR
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-4200
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Country | US
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Telephone | 850-267-9010
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Fax | 850-267-0677
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Provider Business Mailing Address
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Address Line | 1950 BLUEWATER BLVD SUITE 101
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City | NICEVILLE
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State | FL
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Zip | 32578-3888
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Country | US
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Telephone | 850-897-3334
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Fax | 850-897-7855
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MS. NICOLE SHEPPARD
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Credential |
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Telephone | 850-897-3334
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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 |
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License Number State |
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