Provider Demographics
NPI:1407256449
Name:ADVANCED PHYSICAL THERAPY AND SPORTS MEDICINE CENTER, INC.
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY AND SPORTS MEDICINE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMIELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-240-1749
Mailing Address - Street 1:11003 SW HAWKVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-2715
Mailing Address - Country:US
Mailing Address - Phone:772-240-1749
Mailing Address - Fax:
Practice Address - Street 1:11003 SW HAWKVIEW CIR
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-2715
Practice Address - Country:US
Practice Address - Phone:772-240-1749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20885225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
106816Medicare Oscar/Certification