Provider Demographics
NPI:1801827902
Name:OCOEE PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:OCOEE PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CHT
Authorized Official - Phone:423-559-1537
Mailing Address - Street 1:3112 OCOEE ST N
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-5382
Mailing Address - Country:US
Mailing Address - Phone:423-559-1537
Mailing Address - Fax:423-559-1539
Practice Address - Street 1:3112 OCOEE ST N
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-5382
Practice Address - Country:US
Practice Address - Phone:423-559-1537
Practice Address - Fax:423-559-1539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN192907OtherTENNCARE ID NUMBER
TN3651441Medicaid
TN686135OtherACN ID NUMBER
TN192907OtherTENNCARE ID NUMBER
TN3651441Medicare ID - Type UnspecifiedGROUP NUMBER
TN=========OtherCIGNA, UHC, CARITEN ID NU