Provider Demographics
NPI:1104643576
Name:VICTORY PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:VICTORY PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:N
Authorized Official - Last Name:BEBAWEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:754-215-8400
Mailing Address - Street 1:10211 HUNT CLUB LN
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-4570
Mailing Address - Country:US
Mailing Address - Phone:561-827-1400
Mailing Address - Fax:
Practice Address - Street 1:3350 NW 2ND AVE STE B22
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6678
Practice Address - Country:US
Practice Address - Phone:754-215-8400
Practice Address - Fax:949-703-7874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-25
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty