Provider Demographics
NPI:1609951524
Name:ATLANTIC PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:ATLANTIC PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:IANNETTONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:305-672-6474
Mailing Address - Street 1:736 ARTHUR GODFREY ROAD
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3414
Mailing Address - Country:US
Mailing Address - Phone:305-672-6474
Mailing Address - Fax:305-672-6482
Practice Address - Street 1:736 ARTHUR GODFREY ROAD
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3414
Practice Address - Country:US
Practice Address - Phone:305-672-6474
Practice Address - Fax:305-672-6482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2011-03-04
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1181Medicare ID - Type Unspecified