Provider Demographics
NPI:1154720530
Name:PLENITUDE IN-HOME PHYSICAL THERAPY
Entity type:Organization
Organization Name:PLENITUDE IN-HOME PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:VELOSA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:954-440-9767
Mailing Address - Street 1:4203 VINEYARD CIR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33332-2152
Mailing Address - Country:US
Mailing Address - Phone:954-440-9767
Mailing Address - Fax:954-653-4180
Practice Address - Street 1:4203 VINEYARD CIR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33332-2152
Practice Address - Country:US
Practice Address - Phone:954-440-9767
Practice Address - Fax:954-653-4180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW111191041C0700X
FLPT7749225100000X
FLOT9152225X00000X
FLSA9152235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty