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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
1880 59TH ST W, BRADENTON, FL 34209-4630
(941) 792-0511
(941) 792-0560
Mailing address
PO BOX 1156, ELLENTON, FL 34222-1156
(941) 729-0003
(941) 729-0004
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 PROVIDER NUM
FL
05
—
888322000
—
FL
01
—
DB5339
RAIL ROAD
FL
01
—
Y910Z
BCBS FACILITY NUMBER
FL
Enumeration date
05/19/2006
Last updated
08/19/2015
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