Provider Demographics
NPI:1760942783
Name:ON THE HOP ORTHO SPORTS & AQUATIC THERAPY LLC
Entity Type:Organization
Organization Name:ON THE HOP ORTHO SPORTS & AQUATIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BORODIAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-719-2872
Mailing Address - Street 1:6032 NW 83RD TER
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-5039
Mailing Address - Country:US
Mailing Address - Phone:561-719-2872
Mailing Address - Fax:954-597-7773
Practice Address - Street 1:7171 N. UNIVERSITY DRIVE
Practice Address - Street 2:SUITE 111
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2902
Practice Address - Country:US
Practice Address - Phone:954-722-9992
Practice Address - Fax:954-597-7773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty