Provider Demographics
NPI:1033318266
Name:ON SITE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:ON SITE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:NOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, CSCS
Authorized Official - Phone:561-632-2160
Mailing Address - Street 1:513 DRIFTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-4813
Mailing Address - Country:US
Mailing Address - Phone:561-632-2160
Mailing Address - Fax:561-842-6458
Practice Address - Street 1:200 ADMIRALS COVE BLVD
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-4046
Practice Address - Country:US
Practice Address - Phone:561-632-2160
Practice Address - Fax:561-842-6458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 20257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5308BMedicare UPIN