Provider Demographics
NPI:1659417376
Name:THAKAR, VINOD (RPT)
Entity Type:Individual
Prefix:
First Name:VINOD
Middle Name:
Last Name:THAKAR
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:LIGHT
Other - Middle Name:
Other - Last Name:REHAB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:INC
Mailing Address - Street 1:11302 SW 55TH ST
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330-4503
Mailing Address - Country:US
Mailing Address - Phone:954-680-9383
Mailing Address - Fax:954-963-7169
Practice Address - Street 1:11302 SW 55TH ST
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33330-4503
Practice Address - Country:US
Practice Address - Phone:954-680-9383
Practice Address - Fax:954-963-7169
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3616225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259342OtherAVMED
FLY4215OtherBLUE CROSS BLUE SHIELD
FLY4215OtherBLUE CROSS BLUE SHIELD
FLY4215YMedicare PIN