Provider Demographics
NPI:1437339819
Name:VIP PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:VIP PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-529-6236
Mailing Address - Street 1:1484 E TERRA MAR DR
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-6839
Mailing Address - Country:US
Mailing Address - Phone:954-529-6236
Mailing Address - Fax:954-946-9630
Practice Address - Street 1:1484 E TERRA MAR DR
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-6839
Practice Address - Country:US
Practice Address - Phone:954-529-6236
Practice Address - Fax:954-946-9630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty