Organization
EASTERSEALS NORTHEAST CENTRAL FLORIDA
Active
Organization
EASTERSEALS NORTHEAST CENTRAL FLORIDA
Active
Other names
Easter Seals
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BEVERLY JOHNSON (CEO (PRESIDENT))
(386) 255-4568
Entity
Organization
Contact information
Practice address
1219 DUNN AVE, DAYTONA BEACH, FL 32114
(386) 255-4568
(386) 258-7677
Mailing address
1219 DUNN AVE, DAYTONA BEACH, FL 32114-2405
(386) 255-4568
(386) 258-7677
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT 14797
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
883828300
—
FL
Enumeration date
10/11/2006
Last updated
05/29/2018
Update your record
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