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General NPI Number Information
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NPI Number | 1962672030
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY ON WHEELS INC
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 11195 MILLPOND GREENS DRIVE
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City | BOYNTON BEACH
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State | FL
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Zip | 33473
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Country | US
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Telephone | 954-257-1196
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Fax | 954-717-1984
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Provider Business Mailing Address
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Address Line | 11195 MILLPOND GREENS DRIVE
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City | BOYNTON BEACH
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State | FL
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Zip | 33473
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Country | US
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Telephone | 954-257-1196
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Fax | 954-717-1984
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MR. DIMITRI COSMIOS
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Credential | MPT
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Telephone | 954-257-1196
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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 | PT19201
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License Number State | FL
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