| |
1812 S Waukesha St, Bonifay, FL 32425-3100 | |
(850) 547-4646 | |
(850) 547-4766 |
Full Name | |
---|---|
Type | Facility |
Speciality | Physical Therapist |
Location | 1812 S Waukesha St, Bonifay, Florida |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1649311879 | NPI | - | NPPES |
Y921V | Other | FL | BCBS FL PROVIDER # |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | PT14591 (Florida) | Primary |
Mailing Address | Practice Location Address |
---|---|
1812 S Waukesha St, Bonifay, FL 32425-3100 Ph: (850) 547-4646 | 1812 S Waukesha St, Bonifay, FL 32425-3100 Ph: (850) 547-4646 |
Benedict Inlayo Florentin, RPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 503 W Montana Ave, Bonifay, FL 32425 Phone: 646-399-5272 |