Provider Demographics
NPI:1457734212
Name:FLORIDA PHYSICAL MEDICINE & PAIN CENTER LLC
Entity Type:Organization
Organization Name:FLORIDA PHYSICAL MEDICINE & PAIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANUREET
Authorized Official - Middle Name:
Authorized Official - Last Name:GARG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-787-9700
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-0267
Mailing Address - Country:US
Mailing Address - Phone:352-787-9700
Mailing Address - Fax:352-787-9703
Practice Address - Street 1:601 E DIXIE AVE
Practice Address - Street 2:STE 101
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5953
Practice Address - Country:US
Practice Address - Phone:352-787-9700
Practice Address - Fax:352-787-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-29
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 12502208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty