Provider Demographics
NPI:1265461800
Name:NIDAGA PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:NIDAGA PHYSICAL THERAPY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NILO
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GALANG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-251-9200
Mailing Address - Street 1:7532 EAGLE POINT DR
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-3481
Mailing Address - Country:US
Mailing Address - Phone:561-251-9200
Mailing Address - Fax:888-446-0193
Practice Address - Street 1:7532 EAGLE POINT DR
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-3481
Practice Address - Country:US
Practice Address - Phone:561-251-9200
Practice Address - Fax:888-446-0193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2024-06-20
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
FLK7859BMedicare Oscar/Certification