Organization
TALLAHASSEE ORTHOPEDIC & SPORTS PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENT C KNISLEY CEO (CHIEF OPERATING OFFICER)
(850) 545-5318
Entity
Organization
Contact information
Practice address
1431 OHIO AVE N, LIVE OAK, FL 32064-4817
(850) 973-3316
(850) 973-1261
Mailing address
1650 LYNDON FARM CT STE 300, LOUISVILLE, KY 40223-5005
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
FL
Enumeration date
12/06/2024
Last updated
12/06/2024
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