Healthcare Provider Details

I. General information

NPI: 1538433552
Provider Name (Legal Business Name): PHYSICAL THERAPY & SPORTS REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 OLD CONGRESS AVE.
WEST PALM BEACH FL
33409
US

IV. Provider business mailing address

1290 OLD CONGRESS AVE.
WEST PALM BEACH FL
33409
US

V. Phone/Fax

Practice location:
  • Phone: 561-312-1120
  • Fax: 954-622-9120
Mailing address:
  • Phone: 561-312-1120
  • Fax: 954-622-9120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT21702
License Number StateFL

VIII. Authorized Official

Name: MR. RICHARD HENRY HOFFMAN
Title or Position: VICE PRESIDENT
Credential:
Phone: 561-312-1120