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General NPI Number Information
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NPI Number | 1891349171
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Entity Type | Organization
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Legal Business Name | CENTRAL FLORIDA CONCUSSION INSTITUTE LLC
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Dates
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Enumeration Date | 07/25/2019
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 305 MAIN ST STE B
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City | AUBURNDALE
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State | FL
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Zip | 33823-4113
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Country | US
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Telephone | 863-247-8267
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Fax | 863-247-8269
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Provider Business Mailing Address
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Address Line | 305 MAIN ST STE B
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City | AUBURNDALE
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State | FL
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Zip | 33823-4113
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Country | US
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Telephone | 863-247-8267
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Fax | 863-247-8269
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Authorized Official
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Title or Position | OWNER, CLINIC DIRECTOR
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Name | ANGELA WESTMORELAND
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Credential |
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Telephone | 863-247-8267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number |
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License Number State |
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