Provider Demographics
NPI:1700892577
Name:TREMBLAY, PHILP M (PT)
Entity type:Individual
Prefix:DR
First Name:PHILP
Middle Name:M
Last Name:TREMBLAY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3122 VICTORY PALM DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32141-6106
Mailing Address - Country:US
Mailing Address - Phone:386-423-6830
Mailing Address - Fax:
Practice Address - Street 1:2568 S RIDGEWOOD AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32141-5980
Practice Address - Country:US
Practice Address - Phone:386-423-0100
Practice Address - Fax:386-428-8631
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15254225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist