Provider Demographics
NPI:1508390923
Name:SOUTH POINT THERAPY SERVICES CORP
Entity Type:Organization
Organization Name:SOUTH POINT THERAPY SERVICES CORP
Other - Org Name:SOUTH POINT THERAPY SERVICES CORP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-200-3220
Mailing Address - Street 1:3850 SW 87TH AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-5474
Mailing Address - Country:US
Mailing Address - Phone:305-200-3220
Mailing Address - Fax:
Practice Address - Street 1:3850 SW 87TH AVE STE 303
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-5474
Practice Address - Country:US
Practice Address - Phone:305-200-3220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12463261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy