Provider Demographics
NPI:1760546295
Name:PEMBROKE PINES PHYSICIANS ASSOCIATES INC
Entity Type:Organization
Organization Name:PEMBROKE PINES PHYSICIANS ASSOCIATES INC
Other - Org Name:PHYSICAL THERAPY NOW DAVIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:KUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-430-8000
Mailing Address - Street 1:2240 SW 70TH AVE STE D
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33317-7112
Mailing Address - Country:US
Mailing Address - Phone:954-430-8000
Mailing Address - Fax:954-212-0150
Practice Address - Street 1:2240 SW 70TH AVE STE D
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33317-7112
Practice Address - Country:US
Practice Address - Phone:954-430-8000
Practice Address - Fax:954-212-0150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0606Medicare PIN