Provider Demographics
NPI:1376509711
Name:BOYNTON SPORT AND BACK PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BOYNTON SPORT AND BACK PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-369-3068
Mailing Address - Street 1:2609 W WOOLBRIGHT RD
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-6634
Mailing Address - Country:US
Mailing Address - Phone:561-369-3068
Mailing Address - Fax:561-734-1020
Practice Address - Street 1:2609 W WOOLBRIGHT RD
Practice Address - Street 2:SUITE 4A
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-6634
Practice Address - Country:US
Practice Address - Phone:561-369-3068
Practice Address - Fax:561-734-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2020-08-22
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
FLY913QOtherBLUE CROSS GROUP NUMBER
FLK2644Medicare ID - Type UnspecifiedGROUP NUMBER