Healthcare Provider Details

I. General information

NPI: 1902235724
Provider Name (Legal Business Name): PHYSICAL THERAPY SPECIALISTS OF WILTON MANORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 NE 26TH ST
WILTON MANORS FL
33305-1416
US

IV. Provider business mailing address

1881 NE 26TH ST
WILTON MANORS FL
33305-1416
US

V. Phone/Fax

Practice location:
  • Phone: 754-206-2031
  • Fax: 754-206-2032
Mailing address:
  • Phone: 754-206-2031
  • Fax: 754-206-2032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberOS8724
License Number StateFL

VIII. Authorized Official

Name: DR. DOMINIC RIGANOTTI R
Title or Position: OWNER
Credential: DO
Phone: 754-206-2031