Provider Demographics
NPI:1639276900
Name:PHYSICAL THERAPY PROFESSIONALS, LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY PROFESSIONALS, LLC
Other - Org Name:PT PROFESSIONALS AND PT PROS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:CLAYTON
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:II
Authorized Official - Credentials:DPT, MTC, ATC
Authorized Official - Phone:321-591-4369
Mailing Address - Street 1:8045 SPYGLASS HILL RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8567
Mailing Address - Country:US
Mailing Address - Phone:321-757-5515
Mailing Address - Fax:
Practice Address - Street 1:8045 SPYGLASS HILL ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7530
Practice Address - Country:US
Practice Address - Phone:321-757-5515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty