Provider Demographics
NPI:1689724650
Name:VENNETT PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:VENNETT PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-969-6125
Mailing Address - Street 1:8462 EGRET MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33412-1556
Mailing Address - Country:US
Mailing Address - Phone:561-776-6275
Mailing Address - Fax:561-964-5301
Practice Address - Street 1:130 JOHN F KENNEDY DR
Practice Address - Street 2:SUITE 132
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33462-1141
Practice Address - Country:US
Practice Address - Phone:561-969-6125
Practice Address - Fax:561-964-5301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT860261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY913MOtherBCBS PROVIDER NUMBER
FLY913MOtherBCBS PROVIDER NUMBER