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General NPI Number Information
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NPI Number | 1356355101
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Entity Type | Organization
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Legal Business Name | LOGISTICS THERAPY OF BROWARD
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 05/02/2008
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Provider Practice Location Address
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Address Line | 1852 N UNIVERSITY DR
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City | PLANTATION
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State | FL
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Zip | 33322-4117
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Country | US
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Telephone | 954-577-3003
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Fax | 954-577-3005
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Provider Business Mailing Address
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Address Line | 1852 N UNIVERSITY DR
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City | PLANTATION
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State | FL
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Zip | 33322-4117
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Country | US
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Telephone | 954-577-3003
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Fax | 954-577-3005
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Authorized Official
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Title or Position | PRESIDENT
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Name | GABRIEL GRULLON
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Credential |
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Telephone | 954-577-3003
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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 |
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License Number State |
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