Provider Demographics
NPI:1366994519
Name:PHI-THERAS REHAB LLC
Entity type:Organization
Organization Name:PHI-THERAS REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:941-257-4763
Mailing Address - Street 1:12450 TAMIAMI TRL S
Mailing Address - Street 2:SUITE E
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-1473
Mailing Address - Country:US
Mailing Address - Phone:941-257-4763
Mailing Address - Fax:941-257-4766
Practice Address - Street 1:12450 TAMIAMI TRL S
Practice Address - Street 2:SUITE E
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-1473
Practice Address - Country:US
Practice Address - Phone:941-257-4763
Practice Address - Fax:941-257-4766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT293532081S0010X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty