Provider Demographics
NPI:1013916675
Name:ACTION PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ACTION PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIBERO
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:561-741-1661
Mailing Address - Street 1:17380 N HWY A1A ALT
Mailing Address - Street 2:SUITE 305
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-5860
Mailing Address - Country:US
Mailing Address - Phone:561-741-1661
Mailing Address - Fax:561-741-1663
Practice Address - Street 1:17380 N HWY A1A ALT
Practice Address - Street 2:SUITE 305
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-5860
Practice Address - Country:US
Practice Address - Phone:561-741-1661
Practice Address - Fax:561-741-1663
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACTION PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-18
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2009Medicare PIN