MEDICARE: FRONTIER THERAPY LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14268544	OTHER		CAQH

General Provider Information

NPI Number	:	1013400118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRONTIER THERAPY LLC.

Provider Business Mailing Address
First Line	:	430 N MILLS AVE STE 4
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-5746
Country	:	US
Telephone Number	:	407-423-0790
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 N MILLS AVE STE 4
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-5746
Country	:	US
Telephone Number	:	407-423-0790
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW WATSON
Credential	:	LMHC
Telephone Number	:	407-497-0760

Provider Enumeration Date	:	06/13/2018
Last Update Date	:	06/13/2018

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Directions to “FRONTIER THERAPY LLC. ” Practice Location

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