Provider Demographics
NPI:1417040726
Name:PROFICIO THERAPY CENTER, INC.
Entity Type:Organization
Organization Name:PROFICIO THERAPY CENTER, INC.
Other - Org Name:MII AMO THERAPY ASSOCIATES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR/ PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:VAN GENT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:954-376-1511
Mailing Address - Street 1:1040 WESTON RD STE 307
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1912
Mailing Address - Country:US
Mailing Address - Phone:954-376-1511
Mailing Address - Fax:915-773-4874
Practice Address - Street 1:1040 WESTON RD STE 307
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-1912
Practice Address - Country:US
Practice Address - Phone:954-376-1511
Practice Address - Fax:915-773-4874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 21147225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty