Provider Demographics
NPI:1871057836
Name:NEXTSTEP ORLANDO
Entity type:Organization
Organization Name:NEXTSTEP ORLANDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIEDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-571-9974
Mailing Address - Street 1:330 HARBOUR ISLE WAY UNIT 1090
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-3979
Mailing Address - Country:US
Mailing Address - Phone:407-571-9974
Mailing Address - Fax:407-571-9979
Practice Address - Street 1:330 HARBOUR ISLE WAY UNIT 1090
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-3979
Practice Address - Country:US
Practice Address - Phone:407-571-9974
Practice Address - Fax:407-571-9979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty