Healthcare Provider Details

I. General information

NPI: 1821119694
Provider Name (Legal Business Name): INTEGRATED PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 NE 123RD ST
NORTH MIAMI FL
33181-2902
US

IV. Provider business mailing address

2142 NE 123RD ST
NORTH MIAMI FL
33181-2902
US

V. Phone/Fax

Practice location:
  • Phone: 305-967-8976
  • Fax: 305-967-8863
Mailing address:
  • Phone: 305-967-8976
  • Fax: 305-967-8863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT17945
License Number StateFL

VIII. Authorized Official

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