=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598869612
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED HEALTH PHYSICAL THERAPY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2006
-----------------------------------------------------
Last Update Date | 03/18/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7796 NW 44TH ST
-----------------------------------------------------
City | LAUDERHILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33351-6204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-353-8847
-----------------------------------------------------
Fax | 954-533-2852
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 966 NAUTILUS ISLE
-----------------------------------------------------
City | DANIA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33004-2356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-476-5928
-----------------------------------------------------
Fax | 954-530-7240
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. DANIELE B D'AMBROSIO
-----------------------------------------------------
Credential | MPT
-----------------------------------------------------
Telephone | 954-608-3075
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 11462
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 0001575
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 17717
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------