Provider Demographics
NPI:1033581194
Name:TOTAL FUNCTIONAL REHABILITATION THERAPY,
Entity Type:Organization
Organization Name:TOTAL FUNCTIONAL REHABILITATION THERAPY,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ALEJANDRO
Authorized Official - Last Name:WALDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:305-613-1966
Mailing Address - Street 1:575 CRANDON BLVD APT 609
Mailing Address - Street 2:
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149-1864
Mailing Address - Country:US
Mailing Address - Phone:305-613-1966
Mailing Address - Fax:
Practice Address - Street 1:104 CRANDON BLVD STE 421C
Practice Address - Street 2:
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149-1407
Practice Address - Country:US
Practice Address - Phone:305-613-1966
Practice Address - Fax:305-365-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20915225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU7820Medicare UPIN