Provider Demographics
NPI:1558794891
Name:EMPOWER PHYSICAL THERAPY
Entity Type:Organization
Organization Name:EMPOWER PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:352-433-1918
Mailing Address - Street 1:7478 SW 60TH AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-6428
Mailing Address - Country:US
Mailing Address - Phone:352-433-1918
Mailing Address - Fax:352-433-0950
Practice Address - Street 1:7478 SW 60TH AVE UNIT A
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-6428
Practice Address - Country:US
Practice Address - Phone:352-433-1918
Practice Address - Fax:352-433-0950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-09
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X
225100000X
FLOT4461225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY90V2OtherBCBS
FL010430200Medicaid