Provider Demographics
NPI:1154069276
Name:CEDAR MOUNTAIN CHARTERED
Entity Type:Organization
Organization Name:CEDAR MOUNTAIN CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KORODY
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT LAC
Authorized Official - Phone:347-610-1688
Mailing Address - Street 1:APOLLO PAIN MANAGEMENT
Mailing Address - Street 2:720 CORTARO DR
Mailing Address - City:SUN CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33573
Mailing Address - Country:US
Mailing Address - Phone:347-610-1688
Mailing Address - Fax:
Practice Address - Street 1:720 CORTARO DR
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-6811
Practice Address - Country:US
Practice Address - Phone:347-610-1688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty