Provider Demographics
NPI:1114001377
Name:CENTER FOR ORTHOPEDIC AND SPORTS PHYSICAL THERAPY P A
Entity Type:Organization
Organization Name:CENTER FOR ORTHOPEDIC AND SPORTS PHYSICAL THERAPY P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAITLIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCARBARY
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:850-656-1837
Mailing Address - Street 1:2615 CENTENNIAL BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-0586
Mailing Address - Country:US
Mailing Address - Phone:850-656-1837
Mailing Address - Fax:850-817-2917
Practice Address - Street 1:2615 CENTENNIAL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-0586
Practice Address - Country:US
Practice Address - Phone:850-656-1837
Practice Address - Fax:850-877-2917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT2671225100000X
FLPT11534225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAK378AMedicare PIN
FLAK378Medicare PIN