Provider Demographics
NPI:1396871414
Name:BOSH PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:BOSH PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:305-981-0609
Mailing Address - Street 1:420 LINCOLN RD
Mailing Address - Street 2:SUITE # 415 & 412
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3019
Mailing Address - Country:US
Mailing Address - Phone:305-981-0609
Mailing Address - Fax:305-867-6373
Practice Address - Street 1:420 LINCOLN RD
Practice Address - Street 2:SUITE # 415 & 412
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-3019
Practice Address - Country:US
Practice Address - Phone:305-981-0609
Practice Address - Fax:305-867-6373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-25
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0016909225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY7934Medicare ID - Type Unspecified