Provider Demographics
NPI:1386822781
Name:PHYSICAL THERAPY SERVICES OF BROOKSVILLE
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SERVICES OF BROOKSVILLE
Other - Org Name:PHYSICAL THERAPY SERVICES OF SUMTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-754-4500
Mailing Address - Street 1:1389 S US 301
Mailing Address - Street 2:
Mailing Address - City:SUMTERVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:33585-5143
Mailing Address - Country:US
Mailing Address - Phone:352-569-1088
Mailing Address - Fax:352-569-1090
Practice Address - Street 1:1389 S US 301
Practice Address - Street 2:
Practice Address - City:SUMTERVILLE
Practice Address - State:FL
Practice Address - Zip Code:33585-5143
Practice Address - Country:US
Practice Address - Phone:352-569-1088
Practice Address - Fax:352-569-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL898225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1786Medicare UPIN