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Organization
SOUTHERN ORTHOPEDIC SPECIALISTS PA
Active
Organization
SOUTHERN ORTHOPEDIC SPECIALISTS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA CARREIRA (CFO)
(850) 785-4344
Entity
Organization
Contact information
Practice address
1827 HARRISON AVE, PANAMA CITY, FL 32405-7605
(850) 872-7022
(850) 872-7021
Mailing address
1827 HARRISON AVE, PANAMA CITY, FL 32405-7605
(850) 872-7022
(850) 872-7021
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT19663
FL
225100000X
Physical Therapist
Primary
PT19943
FL
225X00000X
Occupational Therapist
OT10791
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y901U
BCBS FL
FL
Enumeration date
05/16/2008
Last updated
05/21/2014
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