Provider Demographics
NPI:1891796041
Name:THERAGROUP INC
Entity Type:Organization
Organization Name:THERAGROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:TOMAS
Authorized Official - Last Name:MACHIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:305-604-5591
Mailing Address - Street 1:1815 PURDY AVE
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-1425
Mailing Address - Country:US
Mailing Address - Phone:305-604-5591
Mailing Address - Fax:305-604-5592
Practice Address - Street 1:1815 PURDY AVE
Practice Address - Street 2:SUITE 100A
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-1425
Practice Address - Country:US
Practice Address - Phone:305-604-5591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 13065225100000X
FLOT 10360225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0253ZMedicare ID - Type Unspecified