Provider Demographics
NPI:1972999027
Name:JUPITER PHYSICAL THERAPY
Entity Type:Organization
Organization Name:JUPITER PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUGUST
Authorized Official - Middle Name:
Authorized Official - Last Name:LARUFFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-745-1002
Mailing Address - Street 1:654 W INDIANTOWN RD
Mailing Address - Street 2:STE 109
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7546
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:654 W INDIANTOWN RD
Practice Address - Street 2:STE 109
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7546
Practice Address - Country:US
Practice Address - Phone:561-745-1002
Practice Address - Fax:561-745-7880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 6925225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty