Provider Demographics
NPI:1295891091
Name:PEDIATRIC PHYSICAL THERAPY ON THE MOVE, PA
Entity type:Organization
Organization Name:PEDIATRIC PHYSICAL THERAPY ON THE MOVE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:C
Authorized Official - Last Name:CUELI-DUTIL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:954-383-4239
Mailing Address - Street 1:16322 SW 14TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5121
Mailing Address - Country:US
Mailing Address - Phone:954-383-4239
Mailing Address - Fax:954-435-2810
Practice Address - Street 1:55 WESTON RD
Practice Address - Street 2:SUITE #103
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-1169
Practice Address - Country:US
Practice Address - Phone:954-383-4239
Practice Address - Fax:954-435-2810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT170752251N0400X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Single Specialty
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY8749OtherBCBS PROVIDER NUMBER