Basic Information
| Provider Information | |||||||||
| NPI: | 1336218353 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PHYSICAL THERAPY AND REHABILITATION ASSOCIATES INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 141 SW 94TH TER | ||||||||
| Address2: | |||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333242431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547010528 | ||||||||
| FaxNumber: | 9544736021 | ||||||||
| Practice Location | |||||||||
| Address1: | 141 SW 94TH TER | ||||||||
| Address2: | |||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333242431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547010528 | ||||||||
| FaxNumber: | 9547567532 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2006 | ||||||||
| LastUpdateDate: | 06/22/2009 | ||||||||
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| AuthorizedOfficialLastName: | BULLEN | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER-PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 9547010528 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MSPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT19361 | FL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.