Provider Demographics
NPI:1679020978
Name:CSL PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:CSL PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:JASMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-806-9944
Mailing Address - Street 1:6538 COLLINS AVE # 313
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4694
Mailing Address - Country:US
Mailing Address - Phone:904-806-9944
Mailing Address - Fax:
Practice Address - Street 1:941 VILLAGE TRL
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-9353
Practice Address - Country:US
Practice Address - Phone:904-806-9944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHEPHERD CAPSOL CSL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy