Healthcare Provider Details

I. General information

NPI: 1972875201
Provider Name (Legal Business Name): FLORIDA KEYS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HAMMOCKS TRL APT 2106
KEY LARGO FL
33037-4860
US

IV. Provider business mailing address

PO BOX 371640
KEY LARGO FL
33037-1640
US

V. Phone/Fax

Practice location:
  • Phone: 786-282-0387
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT 25997
License Number StateFL

VIII. Authorized Official

Name: ANASTASSIA GIBSON
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 786-282-0387