Healthcare Provider Details

I. General information

NPI: 1588814511
Provider Name (Legal Business Name): HIGH ENERGY PHYSIOTRAINING, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 12/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 COUNTRY CLUB LN
HALLANDALE BEACH FL
33009-5126
US

IV. Provider business mailing address

3100 COUNTRY CLUB LN
HALLANDALE BEACH FL
33009-5126
US

V. Phone/Fax

Practice location:
  • Phone: 754-581-1605
  • Fax: 954-455-1701
Mailing address:
  • Phone: 754-581-1605
  • Fax: 954-455-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: MRS. CRISTIANE BARBOSA TIMOTEO
Title or Position: OWNER
Credential: PTA, CWT
Phone: 754-581-1605