Provider Demographics
NPI:1548217615
Name:PHYSICAL THERAPY SPECIALISTS OF PINE CASTLE LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SPECIALISTS OF PINE CASTLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OFFICER / MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAWCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:863-547-9793
Mailing Address - Street 1:345 W MICHIGAN ST STE 108
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4465
Mailing Address - Country:US
Mailing Address - Phone:407-888-2255
Mailing Address - Fax:407-888-2446
Practice Address - Street 1:345 W MICHIGAN ST STE 108
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4465
Practice Address - Country:US
Practice Address - Phone:407-888-2255
Practice Address - Fax:407-888-2446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891113400Medicaid
FL891113400Medicaid
FLK7107Medicare ID - Type UnspecifiedBILLINGFISCALINTERMEDIARY