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General NPI Number Information
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NPI Number | 1871974683
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Entity Type | Organization
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Legal Business Name | PT & SPINAL REHAB
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Dates
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Enumeration Date | 06/17/2015
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Last Update Date | 06/17/2015
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Provider Practice Location Address
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Address Line | 17521 US HIGHWAY 441
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City | MOUNT DORA
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State | FL
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Zip | 32757-6737
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Country | US
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Telephone | 352-735-4385
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Fax | 352-735-4386
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Provider Business Mailing Address
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Address Line | 17521 US HIGHWAY 441
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City | MOUNT DORA
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State | FL
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Zip | 32757-6737
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Country | US
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Telephone | 352-735-4385
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Fax | 352-735-4386
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL JOSEPH THOMAS
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Credential | PT
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Telephone | 352-735-4385
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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 | PT27107
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License Number State | FL
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