Provider Demographics
NPI:1689166571
Name:FUNCTIONALLY LIMITLESS, LLC
Entity Type:Organization
Organization Name:FUNCTIONALLY LIMITLESS, LLC
Other - Org Name:LIMITLESS CONCIERGE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOERSMA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:954-325-9395
Mailing Address - Street 1:2585 LYNWOOD PL
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4163
Mailing Address - Country:US
Mailing Address - Phone:954-325-9395
Mailing Address - Fax:844-210-9901
Practice Address - Street 1:2425 N COURTENAY PKWY STE 103
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4181
Practice Address - Country:US
Practice Address - Phone:321-795-4213
Practice Address - Fax:844-210-9901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FUNCTIONALLY LIMITLESS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-05
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26481225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL726167Medicaid