Provider Demographics
NPI:1518055722
Name:PT RPT INC
Entity Type:Organization
Organization Name:PT RPT INC
Other - Org Name:PHYLLIS TANZER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:TANZER
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:954-370-9700
Mailing Address - Street 1:1931 SABAL PALM DR
Mailing Address - Street 2:APT 103
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324
Mailing Address - Country:US
Mailing Address - Phone:954-370-9700
Mailing Address - Fax:954-370-9700
Practice Address - Street 1:1931 SABAL PALM DR
Practice Address - Street 2:APT. 103
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-5960
Practice Address - Country:US
Practice Address - Phone:954-610-5620
Practice Address - Fax:954-370-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT6667225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8845531Medicaid