=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437954153
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DECKER PHYSICAL THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2025
-----------------------------------------------------
Last Update Date | 02/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6490 SW 50TH CT
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34474-5774
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-426-2372
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6490 SW 50TH CT
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34474-5774
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-426-2372
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICAL THERAPIST
-----------------------------------------------------
Name | RYAN DECKER
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 352-426-2372
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------