1073696001 NPI number — IN BALANCE PHYSICAL THERAPY

Table of content: (NPI 1073696001)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073696001 NPI number — IN BALANCE PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IN BALANCE PHYSICAL THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073696001
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17220 SW 84TH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALMETTO BAY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33157-4616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-962-5940
Provider Business Mailing Address Fax Number:
305-675-9232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6030 BIRD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33155-5253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-667-1188
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ACCURSO
Authorized Official First Name:
CATHERINE
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
305-962-5940

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT13145 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com