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General NPI Number Information
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NPI Number | 1730409897
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Entity Type | Organization
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Legal Business Name | GREAT STRIDES PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 06/10/2010
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Last Update Date | 05/10/2012
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Provider Practice Location Address
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Address Line | 19104 CYPRESS GREEN DR
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City | LUTZ
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State | FL
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Zip | 33558-9757
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Country | US
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Telephone | 813-597-8985
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Fax | 813-436-8700
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Provider Business Mailing Address
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Address Line | 19104 CYPRESS GREEN DR
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City | LUTZ
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State | FL
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Zip | 33558-9757
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Country | US
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Telephone | 813-597-8985
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Fax | 813-436-8700
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RICHARD A MAURO
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Credential | P.T.
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Telephone | 813-597-8985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT24674
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License Number State | FL
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