Provider Demographics
NPI:1407916026
Name:PHYSIOTHERAPY SERVICES INC
Entity Type:Organization
Organization Name:PHYSIOTHERAPY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:V
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:954-270-0144
Mailing Address - Street 1:950 N FEDERAL HWY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-4315
Mailing Address - Country:US
Mailing Address - Phone:954-270-0144
Mailing Address - Fax:954-822-8669
Practice Address - Street 1:950 N FEDERAL HWY
Practice Address - Street 2:SUITE 207
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-4315
Practice Address - Country:US
Practice Address - Phone:954-270-0144
Practice Address - Fax:954-822-8669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10143174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEIN
FLK3361AMedicare ID - Type UnspecifiedMCR B ID