Provider Demographics
NPI:1750133484
Name:PATHOS PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:PATHOS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PAPPAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:727-916-1348
Mailing Address - Street 1:17299 NE COUNTY ROAD 1471
Mailing Address - Street 2:
Mailing Address - City:WALDO
Mailing Address - State:FL
Mailing Address - Zip Code:32694-4523
Mailing Address - Country:US
Mailing Address - Phone:727-916-1348
Mailing Address - Fax:
Practice Address - Street 1:6619 1ST AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1305
Practice Address - Country:US
Practice Address - Phone:727-916-1348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty