Provider Demographics
NPI:1841395712
Name:TOWN AND COUNTRY MEDICAL INC
Entity Type:Organization
Organization Name:TOWN AND COUNTRY MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PANTAGES
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:352-873-7555
Mailing Address - Street 1:3200 SW 34TH AVE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7456
Mailing Address - Country:US
Mailing Address - Phone:352-873-7555
Mailing Address - Fax:352-873-7556
Practice Address - Street 1:3200 SW 34TH AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7456
Practice Address - Country:US
Practice Address - Phone:352-873-7555
Practice Address - Fax:352-873-7556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT2594225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY7022OtherBLUE CROSS PROVIDER NUMBE
FLY7022OtherBLUE CROSS PROVIDER NUMBE