Provider Demographics
NPI:1093901787
Name:ONE ON ONE IN HOME PHYSICAL THERAPY-INC
Entity Type:Organization
Organization Name:ONE ON ONE IN HOME PHYSICAL THERAPY-INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:STACEY
Authorized Official - Last Name:GLUCK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:954-663-1539
Mailing Address - Street 1:6141 NW 58TH WAY
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4441
Mailing Address - Country:US
Mailing Address - Phone:954-663-1539
Mailing Address - Fax:954-255-0665
Practice Address - Street 1:6141 NW 58TH WAY
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-4441
Practice Address - Country:US
Practice Address - Phone:954-663-1539
Practice Address - Fax:954-255-0665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8115261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1275669384Medicare UPIN