Provider Demographics
NPI:1881641363
Name:PHYSICAL THERAPY GROUP SERVICES INC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY GROUP SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAUDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LA O
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-273-0812
Mailing Address - Street 1:8181 NW 154TH ST
Mailing Address - Street 2:SUITE 290
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5881
Mailing Address - Country:US
Mailing Address - Phone:305-273-0812
Mailing Address - Fax:305-273-0817
Practice Address - Street 1:8181 NW 154TH ST
Practice Address - Street 2:SUITE 290
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5881
Practice Address - Country:US
Practice Address - Phone:305-273-0812
Practice Address - Fax:305-273-0817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686836Medicare Oscar/Certification