| NPI | 1134585987 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY VANDER HEIDEN Director Of Sports Medicine 407-823-2030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: FL AL 3863) |
| Enumeration Date | 2016-01-10 |
| Last Update Date | 2016-01-10 |