Provider Demographics
NPI:1235137027
Name:ADVANCED ORTHOPAEDIC & SPORTS PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:ADVANCED ORTHOPAEDIC & SPORTS PHYSICAL THERAPY, INC.
Other - Org Name:AOSPT
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS, SCS
Authorized Official - Phone:561-371-6021
Mailing Address - Street 1:1896 PALM BEACH LAKES BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-3513
Mailing Address - Country:US
Mailing Address - Phone:561-371-6021
Mailing Address - Fax:561-686-4815
Practice Address - Street 1:1896 PALM BEACH LAKES BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-3513
Practice Address - Country:US
Practice Address - Phone:561-371-6021
Practice Address - Fax:561-686-4815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0003382225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY2159Medicare ID - Type Unspecified