Provider Demographics
NPI:1639486269
Name:ISLAND PHYSICAL THERAPY CENTER, INC.
Entity Type:Organization
Organization Name:ISLAND PHYSICAL THERAPY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAMI
Authorized Official - Middle Name:H
Authorized Official - Last Name:HOLDINGA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:305-304-6203
Mailing Address - Street 1:880 91ST COURT OCEAN
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-5251
Mailing Address - Country:US
Mailing Address - Phone:305-304-6203
Mailing Address - Fax:
Practice Address - Street 1:13365 OVERSEAS HWY STE 103
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-3513
Practice Address - Country:US
Practice Address - Phone:305-304-6203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty