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General NPI Number Information
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NPI Number | 1366262412
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Entity Type | Organization
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Legal Business Name | PT WITH TLC LLC
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Dates
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Enumeration Date | 10/14/2024
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 614 NW 25TH AVE
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-8793
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Country | US
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Telephone | 347-200-8063
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Fax | 561-237-7843
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Provider Business Mailing Address
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Address Line | 614 NW 25TH AVE
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-8793
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Country | US
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Telephone | 347-200-8063
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Fax | 561-237-7843
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIELA V MOORE
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Credential |
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Telephone | 347-200-8063
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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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