Healthcare Provider Details

I. General information

NPI: 1538723069
Provider Name (Legal Business Name): PHYSICAL THERAPY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13178 SW 30TH ST
MIRAMAR FL
33027-3838
US

IV. Provider business mailing address

13178 SW 30TH ST
MIRAMAR FL
33027-3838
US

V. Phone/Fax

Practice location:
  • Phone: 954-800-0186
  • Fax:
Mailing address:
  • Phone: 954-800-0186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH LEE
Title or Position: PRESIDENT/CEO
Credential: PT
Phone: 954-647-8105