=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225527237
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PINNACLE MOVEMENT AND PERFORMANCE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2018
-----------------------------------------------------
Last Update Date | 06/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2855 S CONGRESS AVE STE C
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33445-7312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-325-8278
-----------------------------------------------------
Fax | 561-962-1567
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2855 S CONGRESS AVE STE C
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33445-7312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-325-8278
-----------------------------------------------------
Fax | 561-962-1567
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | DR. ERIC OTERO
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 407-922-7622
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | PT31829
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------