Provider Demographics
NPI:1205889714
Name:SUNRISE PHYSICAL THERAPY AND REHAB, INC
Entity type:Organization
Organization Name:SUNRISE PHYSICAL THERAPY AND REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/VP
Authorized Official - Prefix:MR
Authorized Official - First Name:BENSON
Authorized Official - Middle Name:P
Authorized Official - Last Name:BAGASAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-732-2422
Mailing Address - Street 1:1501 PRESIDENTIAL WAY STE 20
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-1852
Mailing Address - Country:US
Mailing Address - Phone:561-684-6811
Mailing Address - Fax:561-684-6812
Practice Address - Street 1:1501 PRESIDENTIAL WAY STE 20
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-1852
Practice Address - Country:US
Practice Address - Phone:561-684-6811
Practice Address - Fax:561-684-6812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7481225100000X
FL8860225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty