Provider Demographics
NPI:1700810900
Name:TRIPT, LLC
Entity Type:Organization
Organization Name:TRIPT, LLC
Other - Org Name:PROFORMPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DULLMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:407-671-0433
Mailing Address - Street 1:405 LAKE HOWELL ROAD
Mailing Address - Street 2:SUITE 1031
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5906
Mailing Address - Country:US
Mailing Address - Phone:407-671-0433
Mailing Address - Fax:407-671-2433
Practice Address - Street 1:405 LAKE HOWELL ROAD
Practice Address - Street 2:SUITE 1031
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5906
Practice Address - Country:US
Practice Address - Phone:407-671-0433
Practice Address - Fax:407-671-2433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3897Medicare ID - Type Unspecified