Provider Demographics
NPI:1518566835
Name:PERSONAL CARE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PERSONAL CARE PHYSICAL THERAPY
Other - Org Name:PERSONAL CARE PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAYTSIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:772-238-0702
Mailing Address - Street 1:10560 SW STEPHANIE WAY APT 202
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2328
Mailing Address - Country:US
Mailing Address - Phone:772-238-0702
Mailing Address - Fax:
Practice Address - Street 1:10560 SW STEPHANIE WAY APT 202
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2328
Practice Address - Country:US
Practice Address - Phone:772-238-0702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty