Provider Demographics
NPI:1346377892
Name:MASTERCARE PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:MASTERCARE PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:941-377-6700
Mailing Address - Street 1:5590 BEE RIDGE RD
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1513
Mailing Address - Country:US
Mailing Address - Phone:941-377-6700
Mailing Address - Fax:941-377-3929
Practice Address - Street 1:5590 BEE RIDGE RD
Practice Address - Street 2:SUITE A-1
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1513
Practice Address - Country:US
Practice Address - Phone:941-377-6700
Practice Address - Fax:941-377-3929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0013941225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686554Medicare ID - Type Unspecified