Provider Demographics
NPI:1346819869
Name:DEDICATED PHYSICAL THERAPY AND WELLNESS LLC
Entity Type:Organization
Organization Name:DEDICATED PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:845-545-7778
Mailing Address - Street 1:16131 HAMPTON CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-9261
Mailing Address - Country:US
Mailing Address - Phone:321-609-8870
Mailing Address - Fax:
Practice Address - Street 1:16131 HAMPTON CROSSING DR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-9261
Practice Address - Country:US
Practice Address - Phone:321-609-8870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-19
Last Update Date:2021-06-19
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
FL101583100Medicaid