Healthcare Provider Details

I. General information

NPI: 1174607006
Provider Name (Legal Business Name): PINECREST PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/02/2025
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8935 S DIXIE HWY
PINECREST FL
33156-1619
US

IV. Provider business mailing address

PO BOX 331933
MIAMI FL
33233-1933
US

V. Phone/Fax

Practice location:
  • Phone: 305-722-0568
  • Fax: 305-670-0899
Mailing address:
  • Phone: 305-722-0568
  • Fax: 305-670-0899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT 18067
License Number StateFL

VIII. Authorized Official

Name: MR. RONALD R YACOUB
Title or Position: PRESIDENT
Credential: MSPT, ATC, CSCS
Phone: 305-722-0568