Organization
ORTHOPEDIC & SPORTS PHYSICAL THERAPY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NICOLE SHEPPARD (PRACTICE ADMINISTRATOR)
(850) 897-3334
Entity
Organization
Contact information
Practice address
1950 BLUEWATER BLVD, SUITE 101, NICEVILLE, FL 32578-3888
(850) 897-3334
(850) 897-7855
Mailing address
1950 BLUEWATER BLVD, SUITE 101, NICEVILLE, FL 32578-3888
(850) 897-3334
(850) 897-7855
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8913153-00
—
FL
01
—
Y906W
BCBSFL CLINIC #
FL
Enumeration date
06/02/2006
Last updated
04/28/2016
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