Provider Demographics
NPI:1952836462
Name:DR DEIS PHYSICAL THERAPY CENTRE INC
Entity Type:Organization
Organization Name:DR DEIS PHYSICAL THERAPY CENTRE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEIDRA
Authorized Official - Middle Name:CANTRELL
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:804-931-6864
Mailing Address - Street 1:12030 SILVERLAKE PARK DR
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-9480
Mailing Address - Country:US
Mailing Address - Phone:804-931-6864
Mailing Address - Fax:240-483-4175
Practice Address - Street 1:6965 PIAZZA GRANDE AVE #210
Practice Address - Street 2:210-4
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835
Practice Address - Country:US
Practice Address - Phone:407-906-6007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-23
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 31472261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy