NPIMap

Organization Active NPI

Physical Therapy Specialists of Pine Castle LLC

  • Physical Therapist
  • Orlando, FL
National Provider Identifier
1548217615
Registry record updated Apr 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PHYSICAL THERAPY SPECIALISTS OF PINE CASTLE LLC
Practice address
345 W Michigan St Ste 108
Orlando, FL 32806-4465
Phone
(407) 888-2255
Fax
(407) 888-2446
NPI assigned
May 27, 2006
Last updated
Apr 20, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2021

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

Authorized official

Name
David Krawczyk, PT, DPTNPI 1689611253
Title
Owner / Officer / Managing Member
Phone
(863) 547-9793

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X FL Primary

Addresses

Primary practice location

345 W Michigan St Ste 108
Orlando, FL 32806-4465

Mailing address

345 W Michigan St Ste 108
Orlando, FL 32806-4465
Phone (407) 888-2255

Other practice location 1

5671 S Orange Ave
Orlando, FL 32809-4291
Phone (407) 888-2255

Other identifiers 1

IdentifierTypeStateIssuer
891113400MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050810000153 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0941239990 Receives reassigned benefits from 9 practitioners
Practice locations: Orlando, FL
O20210519002374 FL DME Supplier - Independently-Practicing Physical Therapist 0941239990 Practice locations: Orlando, FL

National Provider Directory

National Provider Directory

Locations

14115 Town Loop Blvd
Orlando, FL 32837
Phone (407) 740-8848

5671 S Orange Ave
Orlando, FL 32809
Phone (407) 888-2255

7300 Sandlake Commons Blvd
Ste 3
Orlando, FL 32819

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618876800000",
    "number": "1548217615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 W MICHIGAN ST STE 108",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328064465",
            "telephone_number": "407-888-2255",
            "fax_number": "407-888-2446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 W MICHIGAN ST STE 108",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328064465",
            "telephone_number": "407-888-2255",
            "fax_number": "407-888-2446"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5671 S ORANGE AVE",
            "address_purpose": "LOCATION",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328094291",
            "country_code": "US",
            "telephone_number": "407-888-2255",
            "fax_number": "407-888-2446",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PHYSICAL THERAPY SPECIALISTS OF PINE CASTLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A",
        "authorized_official_last_name": "KRAWCZYK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER / OFFICER / MANAGING MEMBER",
        "authorized_official_telephone_number": "863-547-9793",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891113400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.