1003126269 NPI number — PHYSICAL THERAPY PLUS BYTHE SEA LLC

Table of content: (NPI 1003126269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003126269 NPI number — PHYSICAL THERAPY PLUS BYTHE SEA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICAL THERAPY PLUS BYTHE SEA LLC
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:
1003126269
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4737 N OCEAN DRIVE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
LAUDERDALE BY THE SEA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33308-2920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-545-4922
Provider Business Mailing Address Fax Number:
954-545-4923

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4747 N OCEAN DRIVE
Provider Second Line Business Practice Location Address:
SUITE 261
Provider Business Practice Location Address City Name:
LAUDERDALE BY THE SEA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33308-2956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-545-4922
Provider Business Practice Location Address Fax Number:
954-545-4923
Provider Enumeration Date:
10/20/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ERASMUS
Authorized Official First Name:
CLINTON
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
954-545-4922

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PTA19828 , 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)

  • Identifier: PT 17504 . This is a "PT FL LICENSURE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: PT10772 . This is a "LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: PT26044 . This is a "PT FL LICENSURE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: PTA19828 . This is a "LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: PTA23157 . This is a "PTA FL LICENSURE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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