1760942783 NPI number — ON THE HOP ORTHO SPORTS & AQUATIC THERAPY LLC

Table of content: (NPI 1760942783)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760942783 NPI number — ON THE HOP ORTHO SPORTS & AQUATIC THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ON THE HOP ORTHO SPORTS & AQUATIC THERAPY 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:
1760942783
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6032 NW 83RD TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33067-5039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-719-2872
Provider Business Mailing Address Fax Number:
954-597-7773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7171 N. UNIVERSITY DRIVE
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
TAMARAC
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33321-2902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-722-9992
Provider Business Practice Location Address Fax Number:
954-597-7773
Provider Enumeration Date:
03/25/2019

Additional Information

Authorized Official

Authorized Official Last Name:
BORODIAK
Authorized Official First Name:
IVAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
561-719-2872

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 102468700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com