Provider Demographics
NPI:1225775869
Name:FUNCTIONAL FREEDOM PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:FUNCTIONAL FREEDOM PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOCKER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:850-758-6844
Mailing Address - Street 1:4388 JACK POWELL RD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-8238
Mailing Address - Country:US
Mailing Address - Phone:850-758-6844
Mailing Address - Fax:
Practice Address - Street 1:4388 JACK POWELL RD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-8238
Practice Address - Country:US
Practice Address - Phone:850-758-6844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty