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General NPI Number Information
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NPI Number | 1174607006
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Entity Type | Organization
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Legal Business Name | PINECREST PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 8935 S DIXIE HWY
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City | PINECREST
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State | FL
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Zip | 33156-1619
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Country | US
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Telephone | 305-722-0568
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Fax | 305-670-0899
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Provider Business Mailing Address
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Address Line | PO BOX 331933
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City | MIAMI
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State | FL
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Zip | 33233-1933
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Country | US
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Telephone | 305-722-0568
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Fax | 305-670-0899
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RONALD R YACOUB
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Credential | MSPT, ATC, CSCS
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Telephone | 305-722-0568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT 18067
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License Number State | FL
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