Provider Demographics
NPI:1326274747
Name:PHYSICAL THERAPY ASSOC OF MIRAMAR
Entity Type:Organization
Organization Name:PHYSICAL THERAPY ASSOC OF MIRAMAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-961-0511
Mailing Address - Street 1:3190 S STATE ROAD 7 STE 12B
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-5280
Mailing Address - Country:US
Mailing Address - Phone:954-961-0511
Mailing Address - Fax:
Practice Address - Street 1:3190 S STATE ROAD 7 STE 12B
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-5280
Practice Address - Country:US
Practice Address - Phone:954-961-0511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DC MD HOLDINGS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA40344173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173C00000XOther Service ProvidersReflexologistGroup - Single Specialty