Provider Demographics
NPI:1699819185
Name:PREVENTION PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PREVENTION PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:954-224-2649
Mailing Address - Street 1:3340 OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-7144
Mailing Address - Country:US
Mailing Address - Phone:954-224-2649
Mailing Address - Fax:954-252-2149
Practice Address - Street 1:3340 OVERLOOK RD
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-7144
Practice Address - Country:US
Practice Address - Phone:954-224-2649
Practice Address - Fax:954-252-2149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888806000Medicaid