1659825891 NPI number — FLORIDA MOVEMENT THERAPY CENTER-GARDENS LLC

Table of content: (NPI 1659825891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659825891 NPI number — FLORIDA MOVEMENT THERAPY CENTER-GARDENS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA MOVEMENT THERAPY CENTER-GARDENS 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:
1659825891
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8645 N MILITARY TRL
Provider Second Line Business Mailing Address:
SUITE 401
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33410-6294
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-510-7136
Provider Business Mailing Address Fax Number:
561-510-7152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8645 N MILITARY TRL
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33410-6294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-510-7136
Provider Business Practice Location Address Fax Number:
561-510-7152
Provider Enumeration Date:
08/04/2016

Additional Information

Authorized Official

Authorized Official Last Name:
GRAY
Authorized Official First Name:
JODI
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
561-733-5083

Provider Taxonomy Codes

  • Taxonomy code: 2251N0400X , with the licence number:  PT3436 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XN1300X , with the licence number: OT9734 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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