Provider Demographics
NPI:1194902817
Name:COMPREHENSIVE PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:COMPREHENSIVE PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:KNICKERBOCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-521-0627
Mailing Address - Street 1:PO BOX 1001
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33526-1001
Mailing Address - Country:US
Mailing Address - Phone:352-521-0627
Mailing Address - Fax:352-521-5958
Practice Address - Street 1:37104 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-5911
Practice Address - Country:US
Practice Address - Phone:352-521-0627
Practice Address - Fax:352-521-5958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT3564OtherSTATE OF FLORIDA