Provider Demographics
NPI:1467767418
Name:WHITE BAY P.T. INC
Entity Type:Organization
Organization Name:WHITE BAY P.T. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PANNUNZIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-430-1061
Mailing Address - Street 1:4465 SW 160TH AVE
Mailing Address - Street 2:100
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5734
Mailing Address - Country:US
Mailing Address - Phone:954-430-1061
Mailing Address - Fax:954-430-1061
Practice Address - Street 1:4465 SW 160TH AVE
Practice Address - Street 2:100
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-5734
Practice Address - Country:US
Practice Address - Phone:954-430-1061
Practice Address - Fax:954-430-1061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-15
Last Update Date:2010-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20707225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty