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General NPI Number Information
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NPI Number | 1639486269
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Entity Type | Organization
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Legal Business Name | ISLAND PHYSICAL THERAPY CENTER, INC.
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Dates
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Enumeration Date | 09/02/2010
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Last Update Date | 09/02/2010
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Provider Practice Location Address
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Address Line | 13365 OVERSEAS HWY STE 103
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City | MARATHON
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State | FL
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Zip | 33050-3513
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Country | US
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Telephone | 305-304-6203
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Fax |
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Provider Business Mailing Address
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Address Line | 880 91ST COURT OCEAN
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City | MARATHON
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State | FL
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Zip | 33050-5251
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Country | US
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Telephone | 305-304-6203
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. CAMI H HOLDINGA
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Credential | PT
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Telephone | 305-304-6203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT17719
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License Number State | FL
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