Provider Demographics
NPI:1679592844
Name:PHYSIOTHERAPY ASSOCIATES INC
Entity type:Organization
Organization Name:PHYSIOTHERAPY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. GROUP BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-264-7734
Mailing Address - Street 1:3820 NORTHDALE BLVD STE 101A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1834
Mailing Address - Country:US
Mailing Address - Phone:813-264-7734
Mailing Address - Fax:
Practice Address - Street 1:6404 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2605
Practice Address - Country:US
Practice Address - Phone:941-782-0201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG89OtherBCBS
FL106773Medicare Oscar/Certification