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
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