Provider Demographics
NPI:1649929068
Name:PARADISE PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:PARADISE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIRECTOR, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLING
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:540-447-6453
Mailing Address - Street 1:403 GIOVANNI DR
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275-3589
Mailing Address - Country:US
Mailing Address - Phone:434-420-0096
Mailing Address - Fax:
Practice Address - Street 1:5023 RINGWOOD MEADOW DRIVE
Practice Address - Street 2:BUILDING F
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34235
Practice Address - Country:US
Practice Address - Phone:941-360-9706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty