Healthcare Provider Details

I. General information

NPI: 1295352904
Provider Name (Legal Business Name): EVERGLADES PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8520 SW 185TH TER
CUTLER BAY FL
33157-7248
US

IV. Provider business mailing address

8520 SW 185TH TER
CUTLER BAY FL
33157-7248
US

V. Phone/Fax

Practice location:
  • Phone: 305-562-5934
  • Fax:
Mailing address:
  • Phone: 305-562-5934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS CONCEPCION
Title or Position: OWNER
Credential: DPT
Phone: 305-562-5934