Provider Demographics
NPI:1487036356
Name:NEUROLOGIC PHYSICAL THERAPY SPECIALIST
Entity Type:Organization
Organization Name:NEUROLOGIC PHYSICAL THERAPY SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOBIAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, NCS
Authorized Official - Phone:407-721-8819
Mailing Address - Street 1:5250 TUNBRIDGE WELLS LN APT 5
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-8762
Mailing Address - Country:US
Mailing Address - Phone:407-721-8819
Mailing Address - Fax:
Practice Address - Street 1:5250 TUNBRIDGE WELLS LN APT 5
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-8762
Practice Address - Country:US
Practice Address - Phone:407-721-8819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20479261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation