Healthcare Provider Details

I. General information

NPI: 1659417376
Provider Name (Legal Business Name): VINOD THAKAR R.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LIGHT REHAB INC

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 09/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11302 SW 55TH ST
COOPER CITY FL
33330-4503
US

IV. Provider business mailing address

11302 SW 55TH ST
COOPER CITY FL
33330-4503
US

V. Phone/Fax

Practice location:
  • Phone: 954-680-9383
  • Fax: 954-963-7169
Mailing address:
  • Phone: 954-680-9383
  • Fax: 954-963-7169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3616
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: