Basic Information
| Provider Information | |||||||||
| NPI: | 1639576432 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICAL THERAPY INSTITUTE AND AQUATIC REHAB INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4971 LE CHALET BLVD | ||||||||
| Address2: | |||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334361418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617335590 | ||||||||
| FaxNumber: | 5617400714 | ||||||||
| Practice Location | |||||||||
| Address1: | 170 N UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330246714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7862725697 | ||||||||
| FaxNumber: | 7863641552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2014 | ||||||||
| LastUpdateDate: | 07/24/2015 | ||||||||
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| AuthorizedOfficialLastName: | PAPA | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5618012535 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.