Provider Demographics
NPI:1689196594
Name:ORGASS, PETER JUSTIN JR (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:JUSTIN
Last Name:ORGASS
Suffix:JR
Gender:M
Credentials:ATC, LAT
Other - Prefix:MR
Other - First Name:PJ
Other - Middle Name:JUSTIN
Other - Last Name:ORGASS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:12413 SPREADING OAK DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-4068
Mailing Address - Country:US
Mailing Address - Phone:352-263-3330
Mailing Address - Fax:
Practice Address - Street 1:5700 SADDLEBROOK WAY
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-4499
Practice Address - Country:US
Practice Address - Phone:352-263-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL36942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer