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Organization
LEGACY HEALTHCARE INC
Active
Organization
LEGACY HEALTHCARE INC
Active
Other names
Legacy Physical Therapy & Sports Training
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CESAR CHACON (ADMINISTRATOR)
(941) 302-9400
Entity
Organization
Contact information
Practice address
7254 S TAMIAMI TRL, SARASOTA, FL 34231-5554
(941) 924-7819
(941) 924-7919
Mailing address
1144 TALLEVAST RD, SUITE 105, SARASOTA, FL 34243-3267
(941) 355-9601
(941) 355-9608
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2989794
AETNA GROUP PROV NUM
FL
01
—
RY8
BCBS FACILITY ID
FL
Enumeration date
05/19/2006
Last updated
07/13/2007
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