Provider Demographics
NPI:1457942039
Name:VALHALLA PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:VALHALLA PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERE
Authorized Official - Middle Name:
Authorized Official - Last Name:MISSIRIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:754-201-1000
Mailing Address - Street 1:6100 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024
Mailing Address - Country:US
Mailing Address - Phone:754-201-1000
Mailing Address - Fax:754-201-1070
Practice Address - Street 1:6100 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024
Practice Address - Country:US
Practice Address - Phone:754-201-1000
Practice Address - Fax:754-201-1070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy