Provider Demographics
NPI:1679357693
Name:DIY PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:DIY PHYSICAL THERAPY LLC
Other - Org Name:DIY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:904-788-6458
Mailing Address - Street 1:PO BOX 2013
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-2013
Mailing Address - Country:US
Mailing Address - Phone:877-797-1532
Mailing Address - Fax:
Practice Address - Street 1:382 NE 191ST ST STE 381172
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-3899
Practice Address - Country:US
Practice Address - Phone:877-797-1532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty