Provider Demographics
NPI:1497941272
Name:IN HOME PHYSICAL THERAPY
Entity Type:Organization
Organization Name:IN HOME PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:CHERYL
Authorized Official - Last Name:GRUSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:954-415-3892
Mailing Address - Street 1:11272 NW 71ST CT
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3866
Mailing Address - Country:US
Mailing Address - Phone:954-415-3892
Mailing Address - Fax:
Practice Address - Street 1:11272 NW 71ST CT
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-3866
Practice Address - Country:US
Practice Address - Phone:954-415-3892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT12159261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7094Medicare PIN