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Organization
TALLAHASSEE ORTHOPEDIC & SPORTS PHYSICAL THERAPY
Active
Organization
TALLAHASSEE ORTHOPEDIC & SPORTS PHYSICAL THERAPY
Active
Other names
Madison Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KENT KNISLEY P.T. (CEO)
(850) 973-3316
Entity
Organization
Contact information
Practice address
257 SW DADE ST, MADISON, FL 32340-2361
(850) 973-3316
(850) 973-1261
Mailing address
PO BOX 13269, TALLAHASSEE, FL 32317-3269
(850) 219-1520
(850) 219-1521
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1376593053
PARENT FACILITY NPI
FL
01
—
883224200
PARENT FACILITY MEDICAID ID
FL
05
—
883224205
—
FL
Enumeration date
03/06/2007
Last updated
07/02/2009
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