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General NPI Number Information
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NPI Number | 1851718563
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Entity Type | Organization
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Legal Business Name | PHYSICIANS BACK & NECK CENTER ORLANDO INC
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Dates
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Enumeration Date | 03/20/2014
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Last Update Date | 03/20/2014
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Provider Practice Location Address
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Address Line | 5979 VINELAND RD SUITE 210
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City | ORLANDO
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State | FL
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Zip | 32819-7800
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Country | US
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Telephone | 407-412-9226
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Fax | 407-650-2888
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Provider Business Mailing Address
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Address Line | 5979 VINELAND RD SUITE 210
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City | ORLANDO
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State | FL
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Zip | 32819-7800
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Country | US
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Telephone | 407-412-9226
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Fax | 407-650-2888
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MS. YINA D FRASURE
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Credential | L.M.T
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Telephone | 407-412-9226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | ME69749
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License Number State | FL
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