Provider Demographics
NPI:1760938559
Name:PHYSICAL THERAPY ATHLETIC CENTER LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY ATHLETIC CENTER LLC
Other - Org Name:PHYSICAL THERAPY NOW BIRD ROAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:RAMON
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:786-202-8610
Mailing Address - Street 1:6840 SW 40TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3762
Mailing Address - Country:US
Mailing Address - Phone:786-202-8610
Mailing Address - Fax:
Practice Address - Street 1:6840 SW 40TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3762
Practice Address - Country:US
Practice Address - Phone:786-202-8610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty