Healthcare Provider Details

I. General information

NPI: 1922564244
Provider Name (Legal Business Name): PHIRIYAPHON SINTHAWACHIWA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 GLADES RD
BOCA RATON FL
33431-6461
US

IV. Provider business mailing address

670 GLADES RD
BOCA RATON FL
33431-6461
US

V. Phone/Fax

Practice location:
  • Phone: 561-495-9511
  • Fax:
Mailing address:
  • Phone: 561-495-9511
  • Fax: 561-990-7426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT43998
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: