Provider Demographics
NPI:1912469099
Name:NEXT PHASE MEDICAL LLC
Entity Type:Organization
Organization Name:NEXT PHASE MEDICAL LLC
Other - Org Name:PHYSICAL THERAPY NOW LARGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WITTLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-275-7668
Mailing Address - Street 1:3690 E BAY DR STE S
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-1946
Mailing Address - Country:US
Mailing Address - Phone:727-275-7668
Mailing Address - Fax:727-275-8427
Practice Address - Street 1:3690 E BAY DR STE S
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-1946
Practice Address - Country:US
Practice Address - Phone:727-275-7668
Practice Address - Fax:727-275-8427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-05
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT19324OtherMEDICAL LICENSE