Provider Demographics
NPI:1689729188
Name:ACTION PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:ACTION PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:GENECCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-741-1661
Mailing Address - Street 1:1515 N FLAGLER DR
Mailing Address - Street 2:#220
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3428
Mailing Address - Country:US
Mailing Address - Phone:561-366-8707
Mailing Address - Fax:561-366-8713
Practice Address - Street 1:1515 N FLAGLER DR
Practice Address - Street 2:#220
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3428
Practice Address - Country:US
Practice Address - Phone:561-366-8707
Practice Address - Fax:561-366-8713
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACTION PHYSICAL THERAPY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-24
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4851593OtherCIGNA
FLY915YOtherBCBSFL
FL4851593OtherCIGNA