=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154049690
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW U PHYSICAL THERAPY OF NORTH MIAMI, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2022
-----------------------------------------------------
Last Update Date | 08/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12550 BISCAYNE BLVD STE 403
-----------------------------------------------------
City | NORTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33181-2537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-675-0703
-----------------------------------------------------
Fax | 347-857-6005
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12550 BISCAYNE BLVD STE 403
-----------------------------------------------------
City | NORTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33181-2537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BORIS POLONSKIY
-----------------------------------------------------
Credential | MS DPT
-----------------------------------------------------
Telephone | 917-306-4109
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------