Healthcare Provider Details

I. General information

NPI: 1467893396
Provider Name (Legal Business Name): PT OT FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 PARK OF COMMERCE DR SUITE 112
BOCA RATON FL
33487-3626
US

IV. Provider business mailing address

751 PARK OF COMMERCE DRIVE SUITE 112
BOCA RATON FL
33487
US

V. Phone/Fax

Practice location:
  • Phone: 561-300-1779
  • Fax:
Mailing address:
  • Phone: 561-300-1779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD HOFFMAN
Title or Position: VP
Credential:
Phone: 561-312-1120