Healthcare Provider Details

I. General information

NPI: 1225856420
Provider Name (Legal Business Name): COGO PHYSIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 NW 7TH AVE
MIAMI FL
33136-1116
US

IV. Provider business mailing address

1000 S DIXIE HWY
HALLANDALE BEACH FL
33009-7044
US

V. Phone/Fax

Practice location:
  • Phone: 954-458-5700
  • Fax:
Mailing address:
  • Phone: 954-458-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. CRAIG COHEN
Title or Position: OWNER-DIRECTOR
Credential: PT
Phone: 305-343-6311