Provider Demographics
NPI:1699211649
Name:ADVANCED PHYSICAL THERAPY OF CENTRAL FLORIDA
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY OF CENTRAL FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PCC TEAM LEADER
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-693-3378
Mailing Address - Street 1:1202 SW 17TH ST
Mailing Address - Street 2:BOX 209-229
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1231
Mailing Address - Country:US
Mailing Address - Phone:352-693-3378
Mailing Address - Fax:
Practice Address - Street 1:2953 TRAVERSE TRL
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-2017
Practice Address - Country:US
Practice Address - Phone:352-693-3378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-15
Last Update Date:2017-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty