Provider Demographics
NPI:1053630566
Name:NORTH BROWARD PHYSICAL THERAPY
Entity type:Organization
Organization Name:NORTH BROWARD PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:PIVNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-588-0983
Mailing Address - Street 1:2301 W SAMPLE RD
Mailing Address - Street 2:BLDG2 SUITE 9A
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3081
Mailing Address - Country:US
Mailing Address - Phone:954-969-5064
Mailing Address - Fax:
Practice Address - Street 1:2301 W SAMPLE RD
Practice Address - Street 2:BLDG2 SUITE 9A
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33073-3081
Practice Address - Country:US
Practice Address - Phone:954-969-5064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty