Provider Demographics
NPI:1487091252
Name:THERAFLEX LLC
Entity type:Organization
Organization Name:THERAFLEX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:VAZ-ANTROBUS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:352-874-6562
Mailing Address - Street 1:600 N HIGHWAY 27
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715-6265
Mailing Address - Country:US
Mailing Address - Phone:352-874-6562
Mailing Address - Fax:352-678-3419
Practice Address - Street 1:600 N HIGHWAY 27
Practice Address - Street 2:SUITE 5
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-6265
Practice Address - Country:US
Practice Address - Phone:352-874-6562
Practice Address - Fax:352-678-3419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 22653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty