Provider Demographics
NPI:1992847479
Name:SEA RANCH PHYSICAL THERAPY CENTER INC
Entity Type:Organization
Organization Name:SEA RANCH PHYSICAL THERAPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:M
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:954-785-4776
Mailing Address - Street 1:103400 OVERSEAS HWY
Mailing Address - Street 2:STE 111
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-2834
Mailing Address - Country:US
Mailing Address - Phone:954-785-4776
Mailing Address - Fax:954-785-9789
Practice Address - Street 1:103400 OVERSEAS HWY
Practice Address - Street 2:STE 111
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-2834
Practice Address - Country:US
Practice Address - Phone:954-785-4776
Practice Address - Fax:954-785-9789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3855261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY916BOtherBLUE SHIELD PROVIDER #
BF044Medicare PIN