Provider Demographics
NPI:1437301025
Name:ENVISION PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:ENVISION PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SERAFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-439-4594
Mailing Address - Street 1:956 INTERNATIONAL PKWY STE 1580
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5219
Mailing Address - Country:US
Mailing Address - Phone:407-936-0314
Mailing Address - Fax:407-936-0316
Practice Address - Street 1:956 INTERNATIONAL PKWY STE 1580
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5219
Practice Address - Country:US
Practice Address - Phone:407-936-0314
Practice Address - Fax:407-936-0316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17963261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center