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NPI Code Detail

MEDICARE: ENCORE PREAKNESS, INC.

MEDICARE: ENCORE PREAKNESS, INC.
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
1235Z00000XSpeech-Language Pathologist
2261QP2000XPhysical Therapy Clinic/Center

General Provider Information

NPI Number : 1053777052
Entity Type Code : Organization
Provider Name (Legal Business Name) : ENCORE PREAKNESS, INC.
Provider Business Mailing Address
First Line : 4025 TAMPA RD STE 1106
Second Line : LEGAL DEPT
City : OLDSMAR
State : FL
Zip : 34677-3213
Country : US
Telephone Number : 888-974-7878
Fax Number : 727-726-1825
Provider Business Practice Location Address
First Line : 13875 W 115TH TER
Second Line : SMRS OFFICE
City : OLATHE
State : KS
Zip : 66062-7937
Country : US
Telephone Number : 913-906-0990
Fax Number :
Authorized Official
Title or Position : VICE PRESIDENT
Name : SUE E OLSEN
Credential : CCC-SLP
Telephone Number : 727-510-3850
Provider Enumeration Date : 01/06/2016
Last Update Date : 04/22/2016

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Directions to “ENCORE PREAKNESS, INC. ” Practice Location

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