Provider Demographics
NPI:1841263464
Name:PALM BEACH AQUATICS & PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:PALM BEACH AQUATICS & PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADRI
Authorized Official - Middle Name:HERNANDEZ
Authorized Official - Last Name:MOTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-865-2800
Mailing Address - Street 1:5130 LINTON BLVD
Mailing Address - Street 2:SUITE H-1
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6596
Mailing Address - Country:US
Mailing Address - Phone:561-865-2800
Mailing Address - Fax:561-865-0097
Practice Address - Street 1:3111 W BOYNTON BEACH BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-4613
Practice Address - Country:US
Practice Address - Phone:561-742-3283
Practice Address - Fax:561-742-3280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDB1527OtherRAILROAD MEDICARE
FLY912HOtherBCBS GROUP NUMBER
FLY90RQOtherBCBS
FLY90RQOtherBCBS