Provider Demographics
NPI:1568490175
Name:PHYSICAL THERAPY ALPHA INC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY ALPHA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLEMENCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:305-283-8466
Mailing Address - Street 1:15251 SW 109TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-3578
Mailing Address - Country:US
Mailing Address - Phone:305-283-8466
Mailing Address - Fax:305-283-8466
Practice Address - Street 1:15251 SW 109TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-3578
Practice Address - Country:US
Practice Address - Phone:305-283-8466
Practice Address - Fax:305-283-8466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 7222251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7779Medicare ID - Type UnspecifiedPHYSICAL THERAPY