MEDICARE: PHOENIX THERAPY SERVICES FL LLC

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

General Provider Information

NPI Number	:	1891467981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX THERAPY SERVICES FL LLC

Provider Business Mailing Address
First Line	:	2630 W BROWARD BLVD # 203-1265
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-1314
Country	:	US
Telephone Number	:	954-826-3496
Fax Number	:

Provider Business Practice Location Address
First Line	:	2630 W BROWARD BLVD # 203-1265
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-1314
Country	:	US
Telephone Number	:	954-826-3496
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CHAZ IMAIRI ABRAMS
Credential	:
Telephone Number	:	954-826-3496

Provider Enumeration Date	:	09/28/2021
Last Update Date	:	09/28/2021

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