=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487321006
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASR PHYSICAL THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2021
-----------------------------------------------------
Last Update Date | 06/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1825 WEST AVE UNIT 7
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33139-1441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-602-3105
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1825 WEST AVE UNIT 7
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33139-1441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-602-3105
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ERIC ALEXANDER
-----------------------------------------------------
Credential | DPT, OCS
-----------------------------------------------------
Telephone | 305-602-3105
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------