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General NPI Number Information
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NPI Number | 1831470483
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Entity Type | Organization
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Legal Business Name | PHYSIOACTIVE LLC
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Dates
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Enumeration Date | 09/08/2011
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Last Update Date | 04/17/2013
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Provider Practice Location Address
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Address Line | 7700 CONGRESS AVE SUITE 2102
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City | BOCA RATON
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State | FL
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Zip | 33487-1352
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Country | US
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Telephone | 561-241-5499
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Fax | 561-241-5498
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Provider Business Mailing Address
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Address Line | 22035 MARTELLA AVE
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City | BOCA RATON
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State | FL
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Zip | 33433-4632
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Country | US
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Telephone | 561-245-7418
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Fax | 561-245-7418
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | ROSSEANE V BRITO
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Credential | PT
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Telephone | 561-245-7418
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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 |
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License Number State |
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