MEDICARE: RESOLUTE PHYSICAL 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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1831804228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESOLUTE PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	2284 LAS VEGAS TRL
Second Line	:
City	:	NAVARRE
State	:	FL
Zip	:	32566-7573
Country	:	US
Telephone Number	:	706-726-0113
Fax Number	:

Provider Business Practice Location Address
First Line	:	2284 LAS VEGAS TRL
Second Line	:
City	:	NAVARRE
State	:	FL
Zip	:	32566-7573
Country	:	US
Telephone Number	:	706-726-0113
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AMBER CALHOUN
Credential	:	DPT
Telephone Number	:	706-726-0113

Provider Enumeration Date	:	01/19/2023
Last Update Date	:	01/19/2023

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