Provider Demographics
NPI:1225527237
Name:PINNACLE MOVEMENT AND PERFORMANCE
Entity Type:Organization
Organization Name:PINNACLE MOVEMENT AND PERFORMANCE
Other - Org Name:PINNACLE MOVEMENT AND PERFORMANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:407-922-7622
Mailing Address - Street 1:990 S ROGERS CIR STE 7
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2836
Mailing Address - Country:US
Mailing Address - Phone:407-572-0313
Mailing Address - Fax:561-962-1567
Practice Address - Street 1:990 S ROGERS CIR STE 7
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2836
Practice Address - Country:US
Practice Address - Phone:407-572-0313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-04
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT31829261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT31829OtherSTATE OF FL, DEPT OF HEALTH, DIVISION OF MEDICAL QUALITY OF ASSURANCE