Healthcare Provider Details

I. General information

NPI: 1285146431
Provider Name (Legal Business Name): FLORIDA MOVEMENT THERAPY CENTER-PLANTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 10/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 N PINE ISLAND RD
PLANTATION FL
33322-5207
US

IV. Provider business mailing address

12040 S JOG RD STE 7
BOYNTON BEACH FL
33437-4164
US

V. Phone/Fax

Practice location:
  • Phone: 561-510-7136
  • Fax: 561-510-7152
Mailing address:
  • Phone: 561-510-7138
  • Fax: 561-510-7152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JODI GRAY
Title or Position: CLINIC DIRECTOR
Credential: PT
Phone: 561-510-7138