Provider Demographics
NPI:1659387314
Name:GARNER PHYSICAL THERAPY CENTER LLC
Entity Type:Organization
Organization Name:GARNER PHYSICAL THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:CARTER
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:813-633-0669
Mailing Address - Street 1:827 CYPRESS VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6838
Mailing Address - Country:US
Mailing Address - Phone:813-633-0669
Mailing Address - Fax:813-633-0881
Practice Address - Street 1:827 CYPRESS VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573-6838
Practice Address - Country:US
Practice Address - Phone:813-633-0669
Practice Address - Fax:813-633-0881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDA6129OtherMEDICARE RAILROAD
FLK4589Medicare ID - Type Unspecified