Provider Demographics
NPI:1205855491
Name:M D THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:M D THERAPY SERVICES, LLC
Other - Org Name:FUSION HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY & CAO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-733-1003
Mailing Address - Street 1:4655 SALISBURY RD STE 110
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0957
Mailing Address - Country:US
Mailing Address - Phone:904-333-9820
Mailing Address - Fax:727-328-2071
Practice Address - Street 1:455 BELCHER RD S
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-5522
Practice Address - Country:US
Practice Address - Phone:727-328-0599
Practice Address - Fax:727-328-2071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106802Medicare Oscar/Certification