Healthcare Provider Details

I. General information

NPI: 1942793807
Provider Name (Legal Business Name): GOOD SAMARITAN PHYSIO-THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2393 SOUTH CONGRESS AVE SUITE 125
WEST PALM BEACH FL
33406
US

IV. Provider business mailing address

5055 NORTHERN LIGHTS DR
GREENACRES FL
33463-2037
US

V. Phone/Fax

Practice location:
  • Phone: 561-253-6382
  • Fax: 561-253-0437
Mailing address:
  • Phone: 561-808-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT27961
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EMMANUEL DANIEL BENONY
Title or Position: CLINICAL DIRECTOR
Credential: DPT
Phone: 561-808-3030