Healthcare Provider Details

I. General information

NPI: 1134439136
Provider Name (Legal Business Name): PREMIER THERAPY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2010
Last Update Date: 10/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19489 ESTUARY DR
BOCA RATON FL
33498-6202
US

IV. Provider business mailing address

19489 ESTUARY DR
BOCA RATON FL
33498-6202
US

V. Phone/Fax

Practice location:
  • Phone: 561-350-1935
  • Fax: 561-404-0133
Mailing address:
  • Phone: 561-350-1935
  • Fax: 561-404-0133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19200
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT9683
License Number StateFL

VIII. Authorized Official

Name: MR. MERRILL NEARMAN
Title or Position: PRESIDENT
Credential: OTR/L
Phone: 561-350-1935