NPIMap

Organization Active NPI

Tript, LLC

Doing business as ProFormPT

  • Physical Therapist
  • Maitland, FL
National Provider Identifier
1700810900
Registry record updated Oct 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
TRIPT, LLC
Doing business as
ProFormPT
Practice address
405 Lake Howell Road
Suite 1031
Maitland, FL 32751-5906
Phone
(407) 671-0433
Fax
(407) 671-2433
NPI assigned
Jul 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2017

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

Authorized official

Name
Edward John Dullmeyer, PTNPI 1518991710
Title
Owner/Physical Therapist
Phone
(407) 671-0433

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 TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

405 Lake Howell Road
Suite 1031
Maitland, FL 32751-5906

Mailing address

405 Lake Howell Road
Suite 1031
Maitland, FL 32751-5906
Phone (407) 671-0433

Other names 1

  • ProFormPT Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050406000629 FL Part B Supplier - Clinic/Group Practice 5395792832 Receives reassigned benefits from 10 practitioners
Practice locations: Maitland, FL

National Provider Directory

National Provider Directory

Locations

1241 Semoran Blvd
Ste 151
Casselberry, FL 32707
Phone (407) 325-7211

405 Lake Howell Rd
Ste 1031
Maitland, FL 32751
Phone (407) 671-0433

405 Lake Howell Rd
Maitland, FL 32751
Phone (407) 671-0433

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507248000000",
    "number": "1700810900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 LAKE HOWELL ROAD",
            "address_2": "SUITE 1031",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327515906",
            "telephone_number": "407-671-0433",
            "fax_number": "407-671-2433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 LAKE HOWELL ROAD",
            "address_2": "SUITE 1031",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327515906",
            "telephone_number": "407-671-0433",
            "fax_number": "407-671-2433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIPT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2017-10-06",
        "status": "A",
        "authorized_official_last_name": "DULLMEYER",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "407-671-0433",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ProFormPT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maitland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2017; 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.