1366656282 NPI number — PHYSICAL THERAPY 4 U INC

Table of content: (NPI 1366656282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366656282 NPI number — PHYSICAL THERAPY 4 U INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICAL THERAPY 4 U INC
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:
1366656282
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1174
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34295-1174
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-697-7737
Provider Business Mailing Address Fax Number:
941-697-1688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2961 PLACIDA RD
Provider Second Line Business Practice Location Address:
STE 11
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34224-8525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-697-7737
Provider Business Practice Location Address Fax Number:
941-697-1688
Provider Enumeration Date:
05/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOTTENFIELD
Authorized Official First Name:
TODD
Authorized Official Middle Name:
DOUGLAS
Authorized Official Title or Position:
PRESIDENT AND THERAPIST
Authorized Official Telephone Number:
941-697-7737

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  FL11482 , 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: 915754 . This is a "UNIVERSAL HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00071384 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1053314914 . This is a "TODD BOTTENFIELD NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 6656660 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: Y043T . This is a "BLUE CROSS PROVIDER ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 64-01818 . This is a "UNITED HEALTHCARE PROV ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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