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General NPI Number Information
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NPI Number | 1487036356
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Entity Type | Organization
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Legal Business Name | NEUROLOGIC PHYSICAL THERAPY SPECIALIST
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Dates
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Enumeration Date | 06/26/2015
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Last Update Date | 06/26/2015
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Provider Practice Location Address
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Address Line | 5250 TUNBRIDGE WELLS LN APT 5
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City | ORLANDO
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State | FL
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Zip | 32812-8762
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Country | US
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Telephone | 407-721-8819
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Fax |
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Provider Business Mailing Address
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Address Line | 5250 TUNBRIDGE WELLS LN APT 5
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City | ORLANDO
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State | FL
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Zip | 32812-8762
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Country | US
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Telephone | 407-721-8819
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | TARA TOBIAS
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Credential | PT, DPT, NCS
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Telephone | 407-721-8819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | PT20479
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License Number State | FL
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