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General NPI Number Information
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NPI Number | 1952836462
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Entity Type | Organization
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Legal Business Name | DR DEIS PHYSICAL THERAPY CENTRE INC
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Dates
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Enumeration Date | 04/23/2017
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Last Update Date | 04/13/2018
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Provider Practice Location Address
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Address Line | 6965 PIAZZA GRANDE AVE #210 210-4
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City | ORLANDO
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State | FL
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Zip | 32835
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Country | US
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Telephone | 407-906-6007
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Fax |
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Provider Business Mailing Address
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Address Line | 12030 SILVERLAKE PARK DR
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City | WINDERMERE
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State | FL
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Zip | 34786-9480
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Country | US
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Telephone | 804-931-6864
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Fax | 240-483-4175
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DEIDRA CANTRELL MORRISON
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Credential | PT, DPT
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Telephone | 804-931-6864
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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 | PT 31472
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License Number State | FL
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