Provider Demographics
NPI:1861487787
Name:BOCA MEDICAL THERAPY
Entity Type:Organization
Organization Name:BOCA MEDICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:TESIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-338-6897
Mailing Address - Street 1:1000 E HILLSBORO BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-3628
Mailing Address - Country:US
Mailing Address - Phone:954-363-7494
Mailing Address - Fax:954-363-7497
Practice Address - Street 1:1000 E HILLSBORO BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-3628
Practice Address - Country:US
Practice Address - Phone:954-363-7494
Practice Address - Fax:954-363-7497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006645111N00000X
FLPT12916174400000X
FLOS60722081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC5812OtherCLINIC