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General NPI Number Information
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NPI Number | 1164965679
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Entity Type | Organization
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Legal Business Name | ON THE GO, HOME PHYSICAL THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 12/01/2016
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Last Update Date | 12/01/2016
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Provider Practice Location Address
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Address Line | 4331 SW 73RD TER
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City | DAVIE
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State | FL
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Zip | 33314-3030
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Country | US
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Telephone | 954-445-4737
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 292711
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City | DAVIE
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State | FL
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Zip | 33329-2711
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Country | US
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Telephone | 954-445-4737
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MRS. IRINA DETATA
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Credential | PT
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Telephone | 954-445-4745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | PT20047
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License Number State | FL
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