Provider Demographics
NPI:1275083206
Name:INNER STRENGTH PHYSICAL THERAPY, LLC.
Entity Type:Organization
Organization Name:INNER STRENGTH PHYSICAL THERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:440-463-6272
Mailing Address - Street 1:64 TARPON BAY CT
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-1505
Mailing Address - Country:US
Mailing Address - Phone:440-463-6272
Mailing Address - Fax:
Practice Address - Street 1:64 TARPON BAY CT
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-1505
Practice Address - Country:US
Practice Address - Phone:440-463-6272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27447261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy