Provider Demographics
NPI:1164721734
Name:PROFESSIONAL PHYSICAL THERAPY GROUP, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL PHYSICAL THERAPY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:RANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT, CMT
Authorized Official - Phone:305-508-8114
Mailing Address - Street 1:12301 SW 39TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3030
Mailing Address - Country:US
Mailing Address - Phone:305-508-8114
Mailing Address - Fax:305-226-5648
Practice Address - Street 1:12301 SW 39TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3030
Practice Address - Country:US
Practice Address - Phone:305-508-8114
Practice Address - Fax:305-226-5648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21343225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty