Provider Demographics
NPI:1538123682
Name:COMPREHENSIVE PHYSICAL THERAPY CARE
Entity Type:Organization
Organization Name:COMPREHENSIVE PHYSICAL THERAPY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROWENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BADENHORST
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:863-453-3701
Mailing Address - Street 1:4517 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-1731
Mailing Address - Country:US
Mailing Address - Phone:863-453-3701
Mailing Address - Fax:
Practice Address - Street 1:1221 W STRATFORD RD
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-8091
Practice Address - Country:US
Practice Address - Phone:863-453-3701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0010746208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3036Medicare PIN