Provider Demographics
NPI:1972611598
Name:PHOENIX THERAPY AND REHABILITATION
Entity Type:Organization
Organization Name:PHOENIX THERAPY AND REHABILITATION
Other - Org Name:ADVANCED THERAPY CENTER OF DELRAY BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-498-1098
Mailing Address - Street 1:15127 S JOG RD STE 210
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-1251
Mailing Address - Country:US
Mailing Address - Phone:561-498-1098
Mailing Address - Fax:561-495-2524
Practice Address - Street 1:15127 S JOG RD STE 210
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-1251
Practice Address - Country:US
Practice Address - Phone:561-498-1098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686752Medicare ID - Type UnspecifiedOUTPATIENT PHYSICAL THERA