Provider Demographics
NPI:1467624874
Name:FREE MOTION PHYSICAL THERAPY OF BREVARD PA
Entity Type:Organization
Organization Name:FREE MOTION PHYSICAL THERAPY OF BREVARD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:RAZZINO
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:321-242-7575
Mailing Address - Street 1:1300 BEDFORD DR STE 105
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1991
Mailing Address - Country:US
Mailing Address - Phone:321-242-7575
Mailing Address - Fax:321-242-7002
Practice Address - Street 1:1982 ROCKLEDGE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3723
Practice Address - Country:US
Practice Address - Phone:321-631-5366
Practice Address - Fax:321-631-5365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
FLOT231225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty