Provider Demographics
NPI:1073559571
Name:PREMIER QUALITY PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:PREMIER QUALITY PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IDALMI
Authorized Official - Middle Name:D
Authorized Official - Last Name:PERERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-819-9755
Mailing Address - Street 1:11300 NW 87TH CT
Mailing Address - Street 2:STE 117- 119
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4586
Mailing Address - Country:US
Mailing Address - Phone:305-819-9755
Mailing Address - Fax:305-819-9753
Practice Address - Street 1:11300 NW 87TH CT
Practice Address - Street 2:STE 117- 119
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-4586
Practice Address - Country:US
Practice Address - Phone:305-819-9755
Practice Address - Fax:305-819-9753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686842Medicare Oscar/Certification