Provider Demographics
NPI:1174540934
Name:PHYSICAL THERAPY PROFESSIONALS & ASSOCIATES, INC.
Entity type:Organization
Organization Name:PHYSICAL THERAPY PROFESSIONALS & ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PT/PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:EMELDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DINOPOL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:386-447-7824
Mailing Address - Street 1:1 FLORIDA PARK DR N STE 110
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3844
Mailing Address - Country:US
Mailing Address - Phone:386-447-7824
Mailing Address - Fax:386-447-7864
Practice Address - Street 1:1 FLORIDA PARK DR N STE 110
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3844
Practice Address - Country:US
Practice Address - Phone:386-447-7824
Practice Address - Fax:386-447-7864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT10906225100000X
225X00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2807OtherPTAN