Provider Demographics
NPI:1174862973
Name:FORT LAUDERDALE PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:FORT LAUDERDALE PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOODKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-202-9009
Mailing Address - Street 1:4800 N FEDERAL HWY
Mailing Address - Street 2:SUTE 203
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4606
Mailing Address - Country:US
Mailing Address - Phone:954-202-9009
Mailing Address - Fax:
Practice Address - Street 1:4800 N FEDERAL HWY
Practice Address - Street 2:SUTE 203
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4606
Practice Address - Country:US
Practice Address - Phone:954-202-9009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty