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General NPI Number Information
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NPI Number | 1164721734
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PHYSICAL THERAPY GROUP, INC.
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Dates
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Enumeration Date | 03/22/2011
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Last Update Date | 03/22/2011
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Provider Practice Location Address
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Address Line | 12301 SW 39TH TER
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City | MIAMI
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State | FL
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Zip | 33175-3030
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Country | US
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Telephone | 305-508-8114
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Fax | 305-226-5648
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Provider Business Mailing Address
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Address Line | 12301 SW 39TH TER
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City | MIAMI
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State | FL
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Zip | 33175-3030
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Country | US
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Telephone | 305-508-8114
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Fax | 305-226-5648
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. NELSON RANGEL
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Credential | MSPT, CMT
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Telephone | 305-508-8114
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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 | PT21343
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License Number State | FL
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