Provider Demographics
NPI:1134402563
Name:TRANSFORM PHYSICAL THERAPY & PILATES LLC
Entity type:Organization
Organization Name:TRANSFORM PHYSICAL THERAPY & PILATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GANZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:305-528-1795
Mailing Address - Street 1:2797 NE 207TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1471
Mailing Address - Country:US
Mailing Address - Phone:305-528-1795
Mailing Address - Fax:
Practice Address - Street 1:2797 NE 207TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1471
Practice Address - Country:US
Practice Address - Phone:305-528-1795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21985225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty