Provider Demographics
NPI:1740239375
Name:PHYSICAL THERAPY CONSULTANTS INC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY CONSULTANTS INC
Other - Org Name:REGIONAL REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:C
Authorized Official - Last Name:DONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:352-688-8066
Mailing Address - Street 1:19387 HIDDEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34604
Mailing Address - Country:US
Mailing Address - Phone:352-688-8066
Mailing Address - Fax:352-799-3899
Practice Address - Street 1:465 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5680
Practice Address - Country:US
Practice Address - Phone:352-688-8066
Practice Address - Fax:352-688-8540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0004876225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL681467196Medicaid
FL886710100Medicaid
FL681467196Medicaid