Provider Demographics
NPI:1013945757
Name:CENTRAL FLORIDA THERAPIST & REHABILITATIVE GROUP, INC.
Entity Type:Organization
Organization Name:CENTRAL FLORIDA THERAPIST & REHABILITATIVE GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REHABILITATIVE SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:RAIFU
Authorized Official - Middle Name:ADEWALE
Authorized Official - Last Name:OLORUNFEMI
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS
Authorized Official - Phone:352-840-0004
Mailing Address - Street 1:7380 SW 60TH AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-6467
Mailing Address - Country:US
Mailing Address - Phone:352-840-0004
Mailing Address - Fax:352-873-2631
Practice Address - Street 1:7380 SW 60TH AVE
Practice Address - Street 2:STE 3
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-6467
Practice Address - Country:US
Practice Address - Phone:352-840-0004
Practice Address - Fax:352-873-2631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT12870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885832200Medicaid
FL885832200Medicaid