Provider Demographics
NPI:1407557986
Name:PELVIC PHYSICAL THERAPY OF THE PALM BEACHES
Entity Type:Organization
Organization Name:PELVIC PHYSICAL THERAPY OF THE PALM BEACHES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:SAMARA
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-830-0619
Mailing Address - Street 1:800 VILLAGE SQUARE XING STE 118
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4540
Mailing Address - Country:US
Mailing Address - Phone:410-830-0619
Mailing Address - Fax:
Practice Address - Street 1:800 VILLAGE SQUARE XING # 118
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4540
Practice Address - Country:US
Practice Address - Phone:410-830-0619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty