Provider Demographics
NPI:1073864609
Name:PHYSICAL THERAPY INSTITUTE AND AQUATIC REHAB, INC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY INSTITUTE AND AQUATIC REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.C.
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPA
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:561-801-2535
Mailing Address - Street 1:4971 LE CHALET BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-1418
Mailing Address - Country:US
Mailing Address - Phone:561-236-3741
Mailing Address - Fax:561-740-0714
Practice Address - Street 1:1815 E COMMERCIAL BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3760
Practice Address - Country:US
Practice Address - Phone:954-446-9178
Practice Address - Fax:954-707-6302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-22
Last Update Date:2013-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBD231Medicare PIN