Provider Demographics
NPI:1477794410
Name:PHYSICAL THERAPY INSTITUTE AND AQUATIC REHAB, INC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY INSTITUTE AND AQUATIC REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-801-2535
Mailing Address - Street 1:2651 IRMA LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-5735
Mailing Address - Country:US
Mailing Address - Phone:561-624-2706
Mailing Address - Fax:561-630-3948
Practice Address - Street 1:9089 N MILITARY TRL
Practice Address - Street 2:STE 36 AND 37
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-5963
Practice Address - Country:US
Practice Address - Phone:561-630-9598
Practice Address - Fax:561-630-9536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-22
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBD231Medicare PIN