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Organization
PHYSIO MED INC
Active
Organization
PHYSIO MED INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTTIE BULL (PRESIDENT)
(352) 589-5595
Entity
Organization
Contact information
Practice address
2765 S BAY ST, EUSTIS, FL 32726-6501
(352) 589-5955
(352) 589-5747
Mailing address
2765 S BAY ST, EUSTIS, FL 32726-6501
(352) 589-5595
(352) 589-5747
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
72890070
AETNA
—
01
—
Q3N
BCBS
FL
Enumeration date
08/04/2006
Last updated
02/02/2022
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