Healthcare Provider Details

I. General information

NPI: 1588945497
Provider Name (Legal Business Name): FLORIDA FITNESS INTERNATIONAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1861 CORDOVA ROAD
FT LAUDERDALE FL
33316
US

IV. Provider business mailing address

1861 CORDOVA ROAD
FT. LAUDERDALE FL
33316
US

V. Phone/Fax

Practice location:
  • Phone: 954-767-8005
  • Fax: 954-767-8085
Mailing address:
  • Phone: 954-767-8005
  • Fax: 954-767-8085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2152
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT6197
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT14421
License Number StateFL

VIII. Authorized Official

Name: MRS. TONKA I. CASCAIS
Title or Position: PRESIDENT
Credential:
Phone: 954-224-0408