Provider Demographics
NPI:1114102647
Name:TPD AND DDD LLC
Entity Type:Organization
Organization Name:TPD AND DDD LLC
Other - Org Name:PERFORMANCE PHYSICAL THERAPY OF ORMOND BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:D'AVY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:386-615-6464
Mailing Address - Street 1:53 N OLD KINGS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-9519
Mailing Address - Country:US
Mailing Address - Phone:386-615-6464
Mailing Address - Fax:386-615-1822
Practice Address - Street 1:53 N OLD KINGS RD
Practice Address - Street 2:SUITE A
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-9519
Practice Address - Country:US
Practice Address - Phone:386-615-6464
Practice Address - Fax:386-615-1822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3807261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3196YMedicare PIN