Provider Demographics
NPI:1043750276
Name:STARACE TOTAL BALANCE PHYSICAL THERAPY P.A.
Entity Type:Organization
Organization Name:STARACE TOTAL BALANCE PHYSICAL THERAPY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOROFPHYSICALTHERAPY/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:STARACE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:732-668-4988
Mailing Address - Street 1:32 BANNBURY LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8848
Mailing Address - Country:US
Mailing Address - Phone:732-668-4988
Mailing Address - Fax:
Practice Address - Street 1:32 BANNBURY LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8848
Practice Address - Country:US
Practice Address - Phone:732-668-4988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT28234225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1689006744OtherINDIVIDUAL NPI