Provider Demographics
NPI:1174762207
Name:PHYSIORX
Entity type:Organization
Organization Name:PHYSIORX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:407-718-5549
Mailing Address - Street 1:2706 REW CIR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4215
Mailing Address - Country:US
Mailing Address - Phone:407-718-5549
Mailing Address - Fax:407-264-8969
Practice Address - Street 1:2706 REW CIR
Practice Address - Street 2:SUITE 400
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4215
Practice Address - Country:US
Practice Address - Phone:407-718-5549
Practice Address - Fax:407-264-8969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 8093225100000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty