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General NPI Number Information
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NPI Number | 1598000184
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL IMPROVEMENTS THERAPY
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Dates
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Enumeration Date | 12/07/2012
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Last Update Date | 12/07/2012
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Provider Practice Location Address
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Address Line | 12840 83RD AVE
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City | ROSELAND
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State | FL
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Zip | 32957
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Country | US
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Telephone | 772-532-0833
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Fax | 772-571-6190
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Provider Business Mailing Address
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Address Line | PO BOX 1175
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City | ROSELAND
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State | FL
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Zip | 32957-1175
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Country | US
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Telephone | 772-532-0833
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Fax | 772-571-6190
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Authorized Official
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Title or Position | OWNER
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Name | SHERRY LEE BLAKE
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Credential | OT
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Telephone | 772-532-0853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | OT2648
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License Number State | FL
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