Provider Demographics
NPI:1174607006
Name:PINECREST PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:PINECREST PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:YACOUB
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT, ATC, CSCS
Authorized Official - Phone:305-722-0568
Mailing Address - Street 1:PO BOX 331933
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33233-1933
Mailing Address - Country:US
Mailing Address - Phone:305-722-0568
Mailing Address - Fax:305-670-0899
Practice Address - Street 1:8935 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-1619
Practice Address - Country:US
Practice Address - Phone:305-722-0568
Practice Address - Fax:305-670-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 18067261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy