Provider Demographics
NPI:1346279122
Name:ACTION PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:ACTION PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:GENECCO
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:561-741-1661
Mailing Address - Street 1:6056 BOYNTON BEACH BLVD
Mailing Address - Street 2:#175
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3584
Mailing Address - Country:US
Mailing Address - Phone:561-572-2027
Mailing Address - Fax:561-572-0399
Practice Address - Street 1:6056 BOYNTON BEACH BLVD
Practice Address - Street 2:SUITE 175
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3584
Practice Address - Country:US
Practice Address - Phone:561-572-2024
Practice Address - Fax:561-572-0397
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACTION PHYSICAL THERAPY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-02
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2009Medicare PIN