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General NPI Number Information
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NPI Number | 1679760250
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Entity Type | Organization
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Legal Business Name | PROACTIVE PHYSICAL THERAPY OF WESLEY CHAPEL INC
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 27311 WESLEY CHAPEL BLVD
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-4287
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Country | US
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Telephone | 813-907-7774
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Fax | 813-907-8774
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Provider Business Mailing Address
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Address Line | 27311 STATE ROAD 54
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-7428
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Country | US
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Telephone | 813-907-7774
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Fax | 813-907-8774
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. DEBORAH HISAMOTO
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Credential |
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Telephone | 813-979-4819
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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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