| NPI | 1750374906 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN R CARUSO Do 863-471-3344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL OS0004638) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA0003689) |
| 225100000X Physical Therapist (Licence: FL PT0016172) | |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2008-11-06 |