Basic Information
| Provider Information | |||||||||
| NPI: | 1538384136 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARKWAY PHYSICAL THERAPY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 491654 | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347491654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527879300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 W NORTH BLVD | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347485063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527879300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 07/15/2008 | ||||||||
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| AuthorizedOfficialLastName: | GOLDSTEIN | ||||||||
| AuthorizedOfficialFirstName: | GERALD | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3527879300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
ID Information
| ID | Type | State | Issuer | Description | Y910 | 01 | FL | BCBS FACILITY NUMBER | OTHER |