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NPI Code Detail

MEDICARE: PLASTICITY BRAIN CENTERS OF ORLANDO, LLC

MEDICARE: PLASTICITY BRAIN CENTERS OF ORLANDO, 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
1101YP2500XProfessional Counselor
2111NN0400XNeurology Chiropractor
3261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1053036616
Entity Type Code : Organization
Provider Name (Legal Business Name) : PLASTICITY BRAIN CENTERS OF ORLANDO, LLC
Provider Business Mailing Address
First Line : 2000 N ALAFAYA TRL STE 600
Second Line :
City : ORLANDO
State : FL
Zip : 32826-4741
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2000 N ALAFAYA TRL STE 600
Second Line :
City : ORLANDO
State : FL
Zip : 32826-4741
Country : US
Telephone Number : 407-955-4222
Fax Number :
Authorized Official
Title or Position : MANAGER OF CENTER SUPPORT
Name : ANGEL POPE
Credential :
Telephone Number : 407-955-4248
Provider Enumeration Date : 10/06/2022
Last Update Date : 10/06/2022

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Directions to “PLASTICITY BRAIN CENTERS OF ORLANDO, LLC ” Practice Location

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