=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265020564
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORE STRONG PHYSICAL THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2021
-----------------------------------------------------
Last Update Date | 03/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 141 NW 20TH ST STE G2
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33431-7964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-701-1287
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 141 NW 20TH ST STE G2
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33431-7964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-701-1287
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | VALENTYNA NESTEROVA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-701-1287
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------