Provider Demographics
NPI:1659825891
Name:FLORIDA MOVEMENT THERAPY CENTER-GARDENS LLC
Entity Type:Organization
Organization Name:FLORIDA MOVEMENT THERAPY CENTER-GARDENS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-733-5083
Mailing Address - Street 1:8645 N MILITARY TRL
Mailing Address - Street 2:SUITE 401
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6294
Mailing Address - Country:US
Mailing Address - Phone:561-510-7136
Mailing Address - Fax:561-510-7152
Practice Address - Street 1:8645 N MILITARY TRL
Practice Address - Street 2:SUITE 401
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-6294
Practice Address - Country:US
Practice Address - Phone:561-510-7136
Practice Address - Fax:561-510-7152
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA MOVEMENT THERAPY CENTERS FOR EXCELLENCE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-04
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT34362251N0400X
FLOT9734225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Multi-Specialty
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Multi-Specialty