Basic Information
| Provider Information | |||||||||
| NPI: | 1467893396 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PT OT FLORIDA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 751 PARK OF COMMERCE DRIVE | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613001779 | ||||||||
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| Practice Location | |||||||||
| Address1: | 751 PARK OF COMMERCE DR | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334873626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613001779 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2013 | ||||||||
| LastUpdateDate: | 01/06/2015 | ||||||||
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| AuthorizedOfficialLastName: | HOFFMAN | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 5613121120 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.