Provider Demographics
NPI:1790116507
Name:DJP VIP ENTERPRISES LLC
Entity Type:Organization
Organization Name:DJP VIP ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOMENIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:POMPILE
Authorized Official - Suffix:
Authorized Official - Credentials:CSCS
Authorized Official - Phone:561-674-5151
Mailing Address - Street 1:799 APPLEBY ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2441
Mailing Address - Country:US
Mailing Address - Phone:561-372-9251
Mailing Address - Fax:561-372-9251
Practice Address - Street 1:4849 LAKE WORTH RD
Practice Address - Street 2:SUITE 203
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3455
Practice Address - Country:US
Practice Address - Phone:561-674-5151
Practice Address - Fax:561-372-9251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-04
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT181602251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty