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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
834 PINEBROOK RD, VENICE, FL 34285-7123
(941) 484-8107
(941) 484-5186
Mailing address
7216 US HIGHWAY 301 N, SUITE 115, ELLENTON, FL 34222-3462
(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 PROV NUMBER
FL
05
—
888322000
—
FL
01
—
Y901X
BCBS FACILITY NUMBER
FL
Enumeration date
05/18/2006
Last updated
07/31/2008
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