=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952762429
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BOCA RATON PEDIATRIC PHYSICAL THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2016
-----------------------------------------------------
Last Update Date | 02/06/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7982 TENNYSON CT
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33433-4144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-362-8593
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7982 TENNYSON CT
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33433-4144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-362-8593
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | CHARI COHEN
-----------------------------------------------------
Credential | P.T.
-----------------------------------------------------
Telephone | 561-362-8593
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------