Provider Demographics
NPI:1366437360
Name:CENTRAL FLORIDA PHYSICAL MEDICINE AND REHABILITATION PA
Entity type:Organization
Organization Name:CENTRAL FLORIDA PHYSICAL MEDICINE AND REHABILITATION PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-365-9553
Mailing Address - Street 1:PO BOX 490216
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34749-0216
Mailing Address - Country:US
Mailing Address - Phone:352-365-9553
Mailing Address - Fax:352-365-0205
Practice Address - Street 1:3261 US HIGHWAY 441/27 STE B2
Practice Address - Street 2:
Practice Address - City:FRUITLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:34731-4492
Practice Address - Country:US
Practice Address - Phone:352-365-9553
Practice Address - Fax:352-365-0205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45486OtherBCBSFL GP NUMBER
FLCH4936OtherPALMETTO GOVT (RAILROAD)
FL259778100Medicaid
FLK1921Medicare PIN