Healthcare Provider Details

I. General information

NPI: 1588627871
Provider Name (Legal Business Name): DOWNSTATE PHYSICAL THERAPY ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10575 NW 11TH CT
PLANTATION FL
33322-6563
US

IV. Provider business mailing address

PO BOX 15488
PLANTATION FL
33318-5488
US

V. Phone/Fax

Practice location:
  • Phone: 954-609-4797
  • Fax: 954-423-3283
Mailing address:
  • Phone: 954-609-4797
  • Fax: 954-423-3283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15798
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15565
License Number StateFL

VIII. Authorized Official

Name: MR. CHRISTOPHER JOHN MAYOTT
Title or Position: PRESIDENT
Credential: PT
Phone: 954-609-4797