=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407916026
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYSIOTHERAPY SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 950 N FEDERAL HWY SUITE 207
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33062-4315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-270-0144
-----------------------------------------------------
Fax | 954-822-8669
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 950 N FEDERAL HWY SUITE 207
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33062-4315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-270-0144
-----------------------------------------------------
Fax | 954-822-8669
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ANTHONY V MOORE
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 954-270-0144
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 10143
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------