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Organization

ORTHO FLORIDA, LLC

Active
Parent organization
ORTHO FLORIDA, LLC
Other names
Provident Orthopedic & Sports Medicine Center
Organization subpart
Yes

Provider details

NPI number
Legal business name
ORTHO FLORIDA, LLC
Authorized official
DANE TRASK (CEO)
(813) 787-1128
Entity
Organization

Contact information

Practice address
801 MARSHALL FARMS RD, OCOEE, FL 34761-3316
(407) 906-3621
Mailing address
751 PARK OF COMMERCE DR STE 112, BOCA RATON, FL 33487-3622

Taxonomy

Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary

Other

Enumeration date
06/18/2019
Last updated
06/18/2019
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