Healthcare Provider Details

I. General information

NPI: 1629695846
Provider Name (Legal Business Name): PAC PT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2020
Last Update Date: 07/03/2020
Certification Date: 07/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21839 HIGH PINE TRL
BOCA RATON FL
33428-3049
US

IV. Provider business mailing address

21839 HIGH PINE TRL
BOCA RATON FL
33428-3049
US

V. Phone/Fax

Practice location:
  • Phone: 561-891-6911
  • Fax:
Mailing address:
  • Phone: 561-891-6911
  • 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: MRS. TATIANA PES
Title or Position: PHYSICAL THERAPIST/CLINIC DIRECTOR
Credential: PT
Phone: 561-891-6911