Provider Demographics
NPI:1871339275
Name:MERRYMAN, MICHAEL KENNETH
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KENNETH
Last Name:MERRYMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6886 INTEGRA COVE BLVD APT 424
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-8906
Mailing Address - Country:US
Mailing Address - Phone:949-235-1448
Mailing Address - Fax:
Practice Address - Street 1:12421 S ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6508
Practice Address - Country:US
Practice Address - Phone:407-859-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-04
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT41661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist