Basic Information
| Provider Information | |||||||||
| NPI: | 1710128020 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACTION PHYSICAL THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2651 IRMA LAKE DR | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334115735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616242706 | ||||||||
| FaxNumber: | 5616303948 | ||||||||
| Practice Location | |||||||||
| Address1: | 2632 W INDIANTOWN RD | ||||||||
| Address2: | |||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334585889 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617447373 | ||||||||
| FaxNumber: | 5617431192 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2009 | ||||||||
| LastUpdateDate: | 09/18/2017 | ||||||||
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| AuthorizedOfficialLastName: | OSWALD | ||||||||
| AuthorizedOfficialFirstName: | ELAINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 5616242706 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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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.