Provider Demographics
NPI:1437345568
Name:SOUTH FLORIDA PHYSICAL THERAPY ASSOCIATES INC
Entity Type:Organization
Organization Name:SOUTH FLORIDA PHYSICAL THERAPY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DEANE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:305-466-5665
Mailing Address - Street 1:1814 NE MIAMI GARDENS DR
Mailing Address - Street 2:#407
Mailing Address - City:N MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-5043
Mailing Address - Country:US
Mailing Address - Phone:305-466-5665
Mailing Address - Fax:
Practice Address - Street 1:18339 NE 19TH AVE
Practice Address - Street 2:
Practice Address - City:N MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-5031
Practice Address - Country:US
Practice Address - Phone:305-466-5665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 20361261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9755Medicare PIN