Provider Demographics
NPI:1295372662
Name:ACUPHYSIO360, LLC
Entity Type:Organization
Organization Name:ACUPHYSIO360, LLC
Other - Org Name:RECUPERY ACTIVE RECOVERY STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHUONG
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-263-6019
Mailing Address - Street 1:245 WHEELHOUSE LN STE 1451
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3696
Mailing Address - Country:US
Mailing Address - Phone:407-878-0507
Mailing Address - Fax:844-904-0880
Practice Address - Street 1:245 WHEELHOUSE LN STE 1451
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3696
Practice Address - Country:US
Practice Address - Phone:407-878-0507
Practice Address - Fax:844-904-0880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-04
Last Update Date:2021-12-07
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103490700Medicaid