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General NPI Number Information
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NPI Number | 1508220203
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Entity Type | Organization
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Legal Business Name | AZ PT INC
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Dates
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Enumeration Date | 04/08/2016
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Last Update Date | 09/08/2016
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Provider Practice Location Address
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Address Line | 10570 S US HIGHWAY 1 SUITE 101
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-5606
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Country | US
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Telephone | 772-212-7436
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Fax | 772-212-7482
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Provider Business Mailing Address
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Address Line | 10570 S US HIGHWAY 1 SUITE 101
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-5606
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Country | US
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Telephone | 771-212-7436
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Fax | 772-212-7482
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Authorized Official
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Title or Position | DIRECTOR/PHYSICAL THERAPIST
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Name | NICOLE J WOJNO
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Credential | DPT
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Telephone | 786-258-3763
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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 | 22612
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License Number State | FL
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