Provider Demographics
NPI:1831244631
Name:QUALITY THERAPY & SENIORS FITNESS CENTER LLC
Entity type:Organization
Organization Name:QUALITY THERAPY & SENIORS FITNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT DIRECTOR-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIUS CAESAR
Authorized Official - Middle Name:ORIAS
Authorized Official - Last Name:LICONG
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CSST,RN
Authorized Official - Phone:407-498-0539
Mailing Address - Street 1:3105 INNOVATION DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-6501
Mailing Address - Country:US
Mailing Address - Phone:407-498-0539
Mailing Address - Fax:877-203-2038
Practice Address - Street 1:3105 INNOVATION DR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6501
Practice Address - Country:US
Practice Address - Phone:407-498-0539
Practice Address - Fax:877-203-2038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy