Provider Demographics
NPI:1790718088
Name:MODERN PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:MODERN PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-988-1200
Mailing Address - Street 1:10610 N 56TH ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-3641
Mailing Address - Country:US
Mailing Address - Phone:813-988-1200
Mailing Address - Fax:813-988-1228
Practice Address - Street 1:10610 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-3641
Practice Address - Country:US
Practice Address - Phone:813-988-1200
Practice Address - Fax:813-988-1228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7877225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty