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General NPI Number Information
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NPI Number | 1841538113
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Entity Type | Organization
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Legal Business Name | BASE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 01/22/2013
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Last Update Date | 04/17/2014
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Provider Practice Location Address
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Address Line | 1989 CAPITAL CIR NE SUITE 9
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4493
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Country | US
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Telephone | 850-727-5406
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Fax | 850-727-5764
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Provider Business Mailing Address
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Address Line | PO BOX 14344
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City | TALLAHASSEE
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State | FL
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Zip | 32317-4344
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Country | US
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Telephone | 850-727-5406
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Fax | 850-727-5764
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS M LARSON
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Credential | MPT
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Telephone | 850-508-7831
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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 |
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License Number State |
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