Provider Demographics
NPI:1356353437
Name:PHYSICAL THERAPY IN YOUR HOME INC
Entity type:Organization
Organization Name:PHYSICAL THERAPY IN YOUR HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MCCORMACK
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:561-789-2046
Mailing Address - Street 1:2170 SW 7TH CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-6951
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7200 W CAMINO REAL
Practice Address - Street 2:SUITE 101
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5511
Practice Address - Country:US
Practice Address - Phone:561-237-2488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 4994261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3208Medicare ID - Type UnspecifiedMEDICARE PART B PROVIDER