Provider Demographics
NPI:1902034598
Name:PHYSICAL THERAPY GROUP OF FLORIDA, LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY GROUP OF FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:SERIANNI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:954-491-2021
Mailing Address - Street 1:2800 E COMMERCIAL BLVD
Mailing Address - Street 2:209
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4229
Mailing Address - Country:US
Mailing Address - Phone:954-491-2021
Mailing Address - Fax:954-622-9791
Practice Address - Street 1:2800 E COMMERCIAL BLVD
Practice Address - Street 2:209
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4229
Practice Address - Country:US
Practice Address - Phone:954-491-2021
Practice Address - Fax:954-622-9791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
FLPT19361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCB895AOtherMEDICARE PTAN