Provider Demographics
NPI:1508817537
Name:PHYSIOTHERAPY PLUS INC
Entity Type:Organization
Organization Name:PHYSIOTHERAPY PLUS INC
Other - Org Name:FYZICAL THERAPY & BALANCE CENTERS OF ORLANDO (FYZICAL WEST ORLANDO)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIR
Authorized Official - Prefix:
Authorized Official - First Name:IDLER
Authorized Official - Middle Name:
Authorized Official - Last Name:BONHOMME
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, MPT, DPT
Authorized Official - Phone:321-369-9133
Mailing Address - Street 1:6388 SILVER STAR RD
Mailing Address - Street 2:1E
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-3235
Mailing Address - Country:US
Mailing Address - Phone:321-369-9133
Mailing Address - Fax:888-696-1020
Practice Address - Street 1:6388 SILVER STAR RD STE 1E
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-3235
Practice Address - Country:US
Practice Address - Phone:321-369-9133
Practice Address - Fax:888-696-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 21887225100000X
FLMA 32752225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100816700Medicaid
FL017686500Medicaid
FL891208400Medicaid
FLAB733Medicare PIN