Basic Information
| Provider Information | |||||||||
| NPI: | 1033353339 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDPRO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3201 W COMMERCIAL BLVD STE 116 | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333093444 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 3201 W COMMERCIAL BLVD STE 116 | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333093444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543324445 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2009 | ||||||||
| LastUpdateDate: | 04/30/2009 | ||||||||
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| AuthorizedOfficialLastName: | GIBILISCO | ||||||||
| AuthorizedOfficialFirstName: | TRICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF INTERNATIONAL THERAPY | ||||||||
| AuthorizedOfficialTelephone: | 8666082670 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 3644 | NM | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.