Provider Demographics
NPI:1821287574
Name:FLORIDA PHYSICAL THERAPY SPECIALISTS PA
Entity Type:Organization
Organization Name:FLORIDA PHYSICAL THERAPY SPECIALISTS PA
Other - Org Name:DOCTORS CHOICE PHYSICAL THERAPY PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OCIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:BETANCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:941-426-8100
Mailing Address - Street 1:PO BOX 380967
Mailing Address - Street 2:
Mailing Address - City:MURDOCK
Mailing Address - State:FL
Mailing Address - Zip Code:33938-0967
Mailing Address - Country:US
Mailing Address - Phone:941-828-3641
Mailing Address - Fax:941-830-8370
Practice Address - Street 1:12767 TAMIAMI TRL S
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-1934
Practice Address - Country:US
Practice Address - Phone:941-426-8100
Practice Address - Fax:941-426-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT15536174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDO5166OtherRAILROAD MEDICARE
FLP00686970OtherRAILROAD MEDICARE
FLDO5166OtherRAILROAD MEDICARE