Provider Demographics
NPI:1033518436
Name:BROWARD PHYSICAL MEDICINE
Entity Type:Organization
Organization Name:BROWARD PHYSICAL MEDICINE
Other - Org Name:SOUTH FLORIDA SPINE AND REHAB CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDNET
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-729-7092
Mailing Address - Street 1:PO BOX 15888
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33416-5888
Mailing Address - Country:US
Mailing Address - Phone:561-729-7089
Mailing Address - Fax:
Practice Address - Street 1:2121 W OAKLAND PARK BLVD
Practice Address - Street 2:SUIT 10B
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311-1529
Practice Address - Country:US
Practice Address - Phone:954-617-1011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty