Healthcare Provider Details

I. General information

NPI: 1649344060
Provider Name (Legal Business Name): SUNSHINE PHYSICAL THERAPY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 17TH AVE
VERO BEACH FL
32960-3641
US

IV. Provider business mailing address

2975 PIEDMONT PL SW
VERO BEACH FL
32968-5091
US

V. Phone/Fax

Practice location:
  • Phone: 772-562-6877
  • Fax:
Mailing address:
  • Phone: 772-564-6141
  • Fax: 772-564-6141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number10948
License Number StateFL

VIII. Authorized Official

Name: MRS. MICHELLE LYNN DORFMAN
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR
Phone: 772-562-6877