Provider Demographics
NPI:1275506305
Name:PHYSICAL THERAPY SERVICES OF BROOKSVILLE INC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SERVICES OF BROOKSVILLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-754-4500
Mailing Address - Street 1:20195 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-3850
Mailing Address - Country:US
Mailing Address - Phone:352-754-4500
Mailing Address - Fax:352-754-9343
Practice Address - Street 1:20195 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-3850
Practice Address - Country:US
Practice Address - Phone:352-754-4500
Practice Address - Fax:352-754-9343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1786Medicare ID - Type Unspecified