Provider Demographics
NPI:1942518295
Name:DELRAY PHYSICAL THERAPY PA
Entity Type:Organization
Organization Name:DELRAY PHYSICAL THERAPY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-455-2195
Mailing Address - Street 1:PO BOX 480427
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33448-0427
Mailing Address - Country:US
Mailing Address - Phone:561-455-2195
Mailing Address - Fax:561-455-2207
Practice Address - Street 1:1911 S FEDERAL HWY
Practice Address - Street 2:SUITE 400
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-3331
Practice Address - Country:US
Practice Address - Phone:561-455-2195
Practice Address - Fax:561-455-2207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty