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General NPI Number Information
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NPI Number | 1902300379
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Entity Type | Organization
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Legal Business Name | PINECREST PT- DAVIE L.L.C.
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Dates
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Enumeration Date | 03/21/2018
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Last Update Date | 07/21/2020
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Provider Practice Location Address
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Address Line | 4900 S UNIVERSITY DR STE 106
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City | DAVIE
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State | FL
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Zip | 33328-3809
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Country | US
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Telephone | 305-722-0568
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 331922
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City | MIAMI
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State | FL
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Zip | 33233-1922
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Country | US
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Telephone | 305-722-0568
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. RONALD RANI YACOUB
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Credential | MSPT
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Telephone | 305-722-0568
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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 | PT18067
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License Number State | FL
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