Organization
FLORIDA SPINE & REHAB CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TY ANTHONY TRUDEAU DC (PHYSICIAN/OWNER)
(407) 772-2225
Entity
Organization
Contact information
Practice address
483 N SEMORAN BLVD STE 104, WINTER PARK, FL 32792-3800
(407) 772-2225
(407) 772-0302
Mailing address
483 N. SEMORAN BLVD, SUITE 104, WINTER PARK, FL 32792-4549
(407) 772-2225
(407) 772-0302
Taxonomy
Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
CH7566
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1235252537
NPI
FL
Enumeration date
07/06/2011
Last updated
01/07/2013
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