Provider Demographics
NPI:1467957977
Name:TALLAHASSEE ORTHOPEDIC & SPORTS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:TALLAHASSEE ORTHOPEDIC & SPORTS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING AND CREDENTIALING COORD
Authorized Official - Prefix:
Authorized Official - First Name:CECILE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-877-8855
Mailing Address - Street 1:PO BOX 13269
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-3269
Mailing Address - Country:US
Mailing Address - Phone:850-877-8855
Mailing Address - Fax:850-877-7627
Practice Address - Street 1:2020 W PENSACOLA ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304-3186
Practice Address - Country:US
Practice Address - Phone:850-877-8855
Practice Address - Fax:850-877-7627
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TALLAHASSEE ORTHOPEDIC & SPORTS PHYSICAL THERAPY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty