Provider Demographics
NPI:1659599702
Name:APALACHICOLA PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:APALACHICOLA PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BROCATO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:850-653-1212
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:APALACHICOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32329-0207
Mailing Address - Country:US
Mailing Address - Phone:850-653-4545
Mailing Address - Fax:850-653-4949
Practice Address - Street 1:111 AVENUE E
Practice Address - Street 2:
Practice Address - City:APALACHICOLA
Practice Address - State:FL
Practice Address - Zip Code:32320-2041
Practice Address - Country:US
Practice Address - Phone:850-653-4545
Practice Address - Fax:850-653-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT12314174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4560Medicare ID - Type UnspecifiedMEDICARE GROUP ID