Provider Demographics
NPI:1891175311
Name:CELEBRATION PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:CELEBRATION PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:321-250-2535
Mailing Address - Street 1:600 NADINA PL
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4959
Mailing Address - Country:US
Mailing Address - Phone:321-250-2535
Mailing Address - Fax:
Practice Address - Street 1:2501 OLD VINELAND RD
Practice Address - Street 2:SUITE 2501
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-5839
Practice Address - Country:US
Practice Address - Phone:321-250-2535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy