Provider Demographics
NPI:1750509501
Name:SALUBRIOUS PHYSIOTHERAPY INC
Entity Type:Organization
Organization Name:SALUBRIOUS PHYSIOTHERAPY INC
Other - Org Name:PHYSIOWORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:GULCZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-743-2508
Mailing Address - Street 1:6327 LUCERNE ST
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-6673
Mailing Address - Country:US
Mailing Address - Phone:561-743-2508
Mailing Address - Fax:561-743-0458
Practice Address - Street 1:6327 LUCERNE ST
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-6673
Practice Address - Country:US
Practice Address - Phone:561-743-2508
Practice Address - Fax:561-743-0458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2009-06-09
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
FLY9726AMedicare ID - Type UnspecifiedPART B REASSIGNED #