| Orlando Sports Medicine Group Inc | |
|
12780 Waterford Lakes Pkwy Suite 115 Orlando FL 32828-4500 | |
| (407) 207-7188 | |
| (407) 207-7103 |
| Full Name | Orlando Sports Medicine Group Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 12780 Waterford Lakes Pkwy, Orlando, Florida |
| Authorized Official Name and Position | Eric Greeno (PRESIDENT) |
| Authorized Official Contact | 4072077188 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Orlando Sports Medicine Group Inc 12780 Waterford Lakes Pkwy Suite 115 Orlando FL 32828-4500 Ph: (407) 207-7188 | Orlando Sports Medicine Group Inc 12780 Waterford Lakes Pkwy Suite 115 Orlando FL 32828-4500 Ph: (407) 207-7188 |
| NPI Number | 1023129178 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 08/19/2008 |
| Medicare PECOS PAC ID | 0840225785 |
|---|---|
| Medicare Enrollment ID | O20141222000499 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023129178 | NPI | - | NPPES |
| Y902T | Other | FL | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Eric D Greeno |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1669574331 PECOS PAC ID: 3375578214 Enrollment ID: I20050930000080 |
| Provider Name | Peter T Buffington |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1053661355 PECOS PAC ID: 5799008884 Enrollment ID: I20141222000871 |
| Provider Name | Brittany A Kilduff |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1336628924 PECOS PAC ID: 2769726744 Enrollment ID: I20181203000025 |
| Provider Name | Jonathan Bastian |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1437704541 PECOS PAC ID: 1153753025 Enrollment ID: I20191114000850 |
| Provider Name | Matthew Cooksey |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1346699527 PECOS PAC ID: 5698180776 Enrollment ID: I20210223002541 |
| Provider Name | Gabriella Armor |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1508312836 PECOS PAC ID: 2264838226 Enrollment ID: I20210831002125 |
| Provider Name | Ryan C Schultz |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1801328869 PECOS PAC ID: 8628476850 Enrollment ID: I20211001001686 |
| Provider Name | Nathaniel P Rotenberger |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1255114179 PECOS PAC ID: 0345604385 Enrollment ID: I20230911000950 |
| Provider Name | Darshan K Ghayal |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1184306383 PECOS PAC ID: 8628431004 Enrollment ID: I20231007000249 |
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