Provider Demographics
NPI:1346646148
Name:XL PHYSICAL THERAPY AND SPORTS REHAB
Entity Type:Organization
Organization Name:XL PHYSICAL THERAPY AND SPORTS REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:C
Authorized Official - Last Name:ZATORSKI
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:954-347-2151
Mailing Address - Street 1:2001 NE 48TH ST
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4517
Mailing Address - Country:US
Mailing Address - Phone:954-347-2151
Mailing Address - Fax:954-566-2409
Practice Address - Street 1:2001 NE 48TH ST
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4517
Practice Address - Country:US
Practice Address - Phone:954-347-2151
Practice Address - Fax:954-566-2409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16359225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT16359OtherFLORIDA STATE LICENSE
FLDE847AMedicare PIN