Healthcare Provider Details

I. General information

NPI: 1942703244
Provider Name (Legal Business Name): PHYSICAL THERAPY NOW MIDTOWN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3288 NW 36TH ST
MIAMI FL
33142-5036
US

IV. Provider business mailing address

3288 NW 36TH ST
MIAMI FL
33142-5036
US

V. Phone/Fax

Practice location:
  • Phone: 305-570-1666
  • Fax: 305-203-0546
Mailing address:
  • Phone: 305-570-1666
  • Fax: 305-203-0546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT20304
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. DONNA LEA FONDA
Title or Position: BILLING/CREDENTIALING MANAGER
Credential:
Phone: 305-517-1219