Healthcare Provider Details

I. General information

NPI: 1073118006
Provider Name (Legal Business Name): I HEART THEARPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 N UNIVERSITY DRIVE
CORAL SPRINGS FL
33067
US

IV. Provider business mailing address

5379 LYONS RD # 106
COCONUT CREEK FL
33073-2810
US

V. Phone/Fax

Practice location:
  • Phone: 561-306-2998
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL PAWELEK
Title or Position: OWNER
Credential:
Phone: 561-306-2998