Provider Demographics
NPI:1336172352
Name:POMPANO PHYSICAL REHABILITATION CENTER, INC
Entity Type:Organization
Organization Name:POMPANO PHYSICAL REHABILITATION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:MR
Authorized Official - First Name:HANY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:954-786-3100
Mailing Address - Street 1:601 E SAMPLE RD
Mailing Address - Street 2:SUITE # 108
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-4443
Mailing Address - Country:US
Mailing Address - Phone:954-786-3100
Mailing Address - Fax:954-786-0231
Practice Address - Street 1:601 E SAMPLE RD
Practice Address - Street 2:SUITE # 108
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-4443
Practice Address - Country:US
Practice Address - Phone:954-786-3100
Practice Address - Fax:954-786-0231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0003225261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY2108Medicare ID - Type UnspecifiedPHYSICAL THERAPIST
FLY2108BMedicare ID - Type UnspecifiedPHYSICAL THERAPIST