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General NPI Number Information
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NPI Number | 1063630218
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Entity Type | Organization
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Legal Business Name | EFFECTIVE PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 4887 LEHTO LN
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City | LAKE WORTH
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State | FL
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Zip | 33461-5338
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Country | US
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Telephone | 561-439-8182
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Fax | 561-968-6692
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Provider Business Mailing Address
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Address Line | 4887 LEHTO LN
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City | LAKE WORTH
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State | FL
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Zip | 33461-5338
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Country | US
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Telephone | 561-439-8182
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Fax | 561-968-6692
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. FERNANDO MIRANDA
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Credential | P.T.
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Telephone | 561-317-1872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT19662
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License Number State | FL
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