Provider Demographics
NPI:1831470798
Name:FLORIDA THERAPY CENTER VIERA LLC
Entity Type:Organization
Organization Name:FLORIDA THERAPY CENTER VIERA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:SIMON
Authorized Official - Last Name:KRONMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:321-255-2084
Mailing Address - Street 1:7640 N WICKHAM RD STE 110
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8147
Mailing Address - Country:US
Mailing Address - Phone:321-255-2084
Mailing Address - Fax:321-255-2087
Practice Address - Street 1:7640 N WICKHAM RD STE 110
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8147
Practice Address - Country:US
Practice Address - Phone:321-255-2084
Practice Address - Fax:321-255-2087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16847261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy