Florida Physical Therapy & Wellness Ctr LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

FLORIDA PHYSICAL THERAPY & WELLNESS CTR LLC

Practice address

2575 Kurt St Ste 106
Eustis, FL 32726-6256

Phone

(352) 357-0091

Fax

(352) 357-0428

NPI assigned

Dec 4, 2006

Last updated

Feb 17, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. John R Dotson, PTA

Title

Owner Administrator

Phone

(352) 357-0091

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225106404. Details of each certification follow.

• CCN 686739 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 686739

Legal name

FLORIDA PHYSICAL THERAPY AND WELLNESS CENTER

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Oct 22, 2004

Last certification

Jan 22, 2025

Ownership / control type

Proprietary

Facility address

2575 Kurt Street Suite 106
Eustis, FL 32726

Locations

Networks

• Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Máximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
• Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297900800000",
    "number": "1225106404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2575 KURT ST STE 106",
            "city": "EUSTIS",
            "state": "FL",
            "postal_code": "327266256",
            "telephone_number": "352-357-0091",
            "fax_number": "352-357-0428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2575 KURT ST STE 106",
            "city": "EUSTIS",
            "state": "FL",
            "postal_code": "327266256",
            "telephone_number": "352-357-0091",
            "fax_number": "352-357-0428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA PHYSICAL THERAPY & WELLNESS CTR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2011-02-17",
        "status": "A",
        "authorized_official_last_name": "DOTSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER ADMINISTRATOR",
        "authorized_official_telephone_number": "352-357-0091",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PTA"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• First Step Therapy LLC
• Bruce Robert Fisher, COTA
• Jeannette J Fisher
• Florida Department of Health (lake county health Department)
• Florida First Care, Inc.
• Flower of the Lake Family Practice PA
• Flower of the Lake Family Practice, PA
• Floyd S Dillard MD PA
• Brittany Forbes
• Vance Forde

• Physical Therapy Clinic/Center in Eustis, FL
• Providers in Eustis, FL by specialty
• Physical Therapy Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.