MEDICARE: DIAMOND HEART INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	PT 10588	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CB2957	OTHER	FL	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1447420963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAMOND HEART INC

Provider Business Mailing Address
First Line	:	3959 S NOVA RD STE 1
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4900
Country	:	US
Telephone Number	:	386-767-0557
Fax Number	:	386-767-3251

Provider Business Practice Location Address
First Line	:	3959 S NOVA RD STE 1
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4900
Country	:	US
Telephone Number	:	386-767-0557
Fax Number	:	386-767-3251

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ATEF FARAH MITRY
Credential	:	PHYSICAL THERAPIST
Telephone Number	:	386-767-0557

Provider Enumeration Date	:	03/12/2008
Last Update Date	:	03/12/2008

Similar Medicare Providers

1174798433 — ORANGE COUNTY NEWBORN MEDICARE CARE PC
Practice Location Address:

3 SAINT STEPHENS PL , SUITE 2
WARWICK, NY
10990-3208

Practice Phone: 845-987-9700
Practice Fax:

1104342062 — ZOE LYON-GOLDMAN LCSW
Practice Location Address:

3959 S NOVA RD STE 12
PORT ORANGE, FL
32127-4900

Practice Phone: 386-227-6590
Practice Fax:

1700745916 — CALMING SHORES CONSULTING, LLC
Practice Location Address:

3959 S NOVA RD STE 12
PORT ORANGE, FL
32127-4900

Practice Phone: 386-227-6105
Practice Fax:

1780543991 — ZLG COUNSELING, LLC
Practice Location Address:

3959 S NOVA RD STE 12
PORT ORANGE, FL
32127-4900

Practice Phone: 386-227-6590
Practice Fax:

1912410838 — DR. NICOLLE J SCHULTZE D.C.
Practice Location Address:

3959 S NOVA RD STE 9
PORT ORANGE, FL
32127-4900

Practice Phone: 727-220-6778
Practice Fax:

1700359759 — PURA VIDA CHIROPRACTIC LLC
Practice Location Address:

3959 S NOVA RD STE 9
PORT ORANGE, FL
32127-4900

Practice Phone: 727-220-6778
Practice Fax: 386-761-2522

Directions to “DIAMOND HEART INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.