Provider Demographics
NPI:1235244575
Name:FLORIDA OCCUPATIONAL PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:FLORIDA OCCUPATIONAL PHYSICAL THERAPY, INC.
Other - Org Name:FLORIDA ORTHOPEDIC PHYSICAL THREAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:HORWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:954-390-7245
Mailing Address - Street 1:3405 NW 9TH AVE
Mailing Address - Street 2:SUITE 1207
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-5943
Mailing Address - Country:US
Mailing Address - Phone:954-390-7245
Mailing Address - Fax:954-390-6167
Practice Address - Street 1:3405 NW 9TH AVE
Practice Address - Street 2:SUITE 1207
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-5943
Practice Address - Country:US
Practice Address - Phone:954-390-7245
Practice Address - Fax:954-390-6167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 5340225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889280600Medicaid
FLK4235Medicare ID - Type UnspecifiedGROUP ID #
FLU0226AMedicare UPIN