Provider Demographics
NPI:1629026315
Name:PHYSICAL THERAPY & FITNESS MANAGEMENT
Entity Type:Organization
Organization Name:PHYSICAL THERAPY & FITNESS MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-874-4616
Mailing Address - Street 1:3399 NW 72ND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1349
Mailing Address - Country:US
Mailing Address - Phone:305-599-9933
Mailing Address - Fax:305-594-2722
Practice Address - Street 1:3399 NW 72ND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122-1349
Practice Address - Country:US
Practice Address - Phone:305-599-9933
Practice Address - Fax:305-594-2722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy