Provider Demographics
NPI:1518211267
Name:PHYSICAL THERAPY CONNECTION LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY CONNECTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF STAFF
Authorized Official - Prefix:
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEIN-NACHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-990-6111
Mailing Address - Street 1:177 HUNTINGTON AVE
Mailing Address - Street 2:STE 1703 PMB 82414
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-0594
Mailing Address - Country:US
Mailing Address - Phone:857-220-8415
Mailing Address - Fax:772-879-6650
Practice Address - Street 1:8414 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-3306
Practice Address - Country:US
Practice Address - Phone:857-990-6111
Practice Address - Fax:833-615-1065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-02
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18972261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008418800Medicaid