Provider Demographics
NPI:1205172947
Name:CENTRAL FLORIDA SPORTS & PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:CENTRAL FLORIDA SPORTS & PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:JARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT, ATC, LAT
Authorized Official - Phone:407-957-6290
Mailing Address - Street 1:PO BOX 700097
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34770-0097
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4237 13TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6732
Practice Address - Country:US
Practice Address - Phone:407-957-6290
Practice Address - Fax:407-891-9183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT10828225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty