Provider Demographics
NPI:1720229032
Name:ACTION PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ACTION PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSWALD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:561-624-2706
Mailing Address - Street 1:2651 IRMA LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-5735
Mailing Address - Country:US
Mailing Address - Phone:561-624-2706
Mailing Address - Fax:561-630-3948
Practice Address - Street 1:7171 N UNIVERSITY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2902
Practice Address - Country:US
Practice Address - Phone:954-722-6551
Practice Address - Fax:954-722-6803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2010-03-04
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
FLK2009AMedicare PIN