Provider Demographics
NPI:1962672030
Name:PHYSICAL THERAPY ON WHEELS INC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY ON WHEELS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DIMITRI
Authorized Official - Middle Name:
Authorized Official - Last Name:COSMIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:954-257-1196
Mailing Address - Street 1:11195 MILLPOND GREENS DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473
Mailing Address - Country:US
Mailing Address - Phone:954-257-1196
Mailing Address - Fax:954-717-1984
Practice Address - Street 1:11195 MILLPOND GREENS DRIVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33473
Practice Address - Country:US
Practice Address - Phone:954-257-1196
Practice Address - Fax:954-717-1984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19201225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty