Provider Demographics
NPI:1003564519
Name:SCIFORM PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:SCIFORM PHYSICAL THERAPY INC
Other - Org Name:PROFORM PHYSICAL THERAPY INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SAILENDRA
Authorized Official - Middle Name:JITENDRAKUMAR
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:524-047-3363
Mailing Address - Street 1:232 CHESTNUT STREET
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-3020
Mailing Address - Country:US
Mailing Address - Phone:352-404-7336
Mailing Address - Fax:352-559-0421
Practice Address - Street 1:232 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-3020
Practice Address - Country:US
Practice Address - Phone:352-404-7336
Practice Address - Fax:352-559-0421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy