Provider Demographics
NPI:1811940471
Name:FOSSITT THERAPY SERVICES, INC.
Entity type:Organization
Organization Name:FOSSITT THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:FOSSITT
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:407-328-5420
Mailing Address - Street 1:289 BRASSINGTON DR
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-2138
Mailing Address - Country:US
Mailing Address - Phone:407-792-8590
Mailing Address - Fax:407-328-5430
Practice Address - Street 1:2015 S MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-3361
Practice Address - Country:US
Practice Address - Phone:407-328-5420
Practice Address - Fax:407-328-5430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 10292261QM1300X
FLSA 1721261QM1300X
FLPT 19048261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8203Medicare ID - Type UnspecifiedMEDICARE NUMBER