Provider Demographics
NPI:1518902832
Name:FOUNDATION PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:FOUNDATION PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT/CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:ARGIRA
Authorized Official - Last Name:PARSONIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, MTC
Authorized Official - Phone:727-784-6088
Mailing Address - Street 1:29605 US HIGHWAY 19 N
Mailing Address - Street 2:SUITE #360
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-1537
Mailing Address - Country:US
Mailing Address - Phone:727-784-6088
Mailing Address - Fax:727-784-3034
Practice Address - Street 1:29605 US HIGHWAY 19 N
Practice Address - Street 2:SUITE #360
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-1537
Practice Address - Country:US
Practice Address - Phone:727-784-6088
Practice Address - Fax:727-784-3034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 00156174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL217792OtherAMERIGROUP
FLDD5262OtherMEDICARE RAILROAD
FLY907WOtherBLUE CROSS
FLY906MOtherBLUE CROSS
FLDD5262OtherMEDICARE RAILROAD
FLY906MOtherBLUE CROSS