Provider Demographics
NPI:1063630218
Name:EFFECTIVE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:EFFECTIVE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-317-1872
Mailing Address - Street 1:4887 LEHTO LN
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-5338
Mailing Address - Country:US
Mailing Address - Phone:561-439-8182
Mailing Address - Fax:561-968-6692
Practice Address - Street 1:4887 LEHTO LN
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-5338
Practice Address - Country:US
Practice Address - Phone:561-439-8182
Practice Address - Fax:561-968-6692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19662225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty