Provider Demographics
NPI:1700153988
Name:KEY BISCAYNE PHYSICAL THERAPY L.L.C.
Entity Type:Organization
Organization Name:KEY BISCAYNE PHYSICAL THERAPY L.L.C.
Other - Org Name:KEY BISCAYNE PHYSICAL THERAPY, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:YACOUB
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:305-302-1828
Mailing Address - Street 1:PO BOX 331931
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33233
Mailing Address - Country:US
Mailing Address - Phone:305-722-0568
Mailing Address - Fax:305-670-0899
Practice Address - Street 1:240 CRANDON BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149-1543
Practice Address - Country:US
Practice Address - Phone:305-722-0568
Practice Address - Fax:305-722-0569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty