Healthcare Provider Details

I. General information

NPI: 1457750408
Provider Name (Legal Business Name): AHC PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 HYPOLUXO RD SUITE 2
LAKE WORTH FL
33463-7534
US

IV. Provider business mailing address

4640 HYPOLUXO RD SUITE 2
LAKE WORTH FL
33463-7534
US

V. Phone/Fax

Practice location:
  • Phone: 561-296-1715
  • Fax: 561-296-1716
Mailing address:
  • Phone: 561-296-1715
  • Fax: 561-296-1716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3901
License Number StateFL

VIII. Authorized Official

Name: MISS MARIANA J HAZELCORN
Title or Position: PRESIDENT
Credential: P.T.
Phone: 561-296-1715