Provider Demographics
NPI:1285146431
Name:FLORIDA MOVEMENT THERAPY CENTER-PLANTATION, LLC
Entity type:Organization
Organization Name:FLORIDA MOVEMENT THERAPY CENTER-PLANTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-510-7138
Mailing Address - Street 1:12040 S JOG RD STE 7
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-4164
Mailing Address - Country:US
Mailing Address - Phone:561-510-7138
Mailing Address - Fax:561-510-7152
Practice Address - Street 1:1825 N PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5207
Practice Address - Country:US
Practice Address - Phone:561-510-7136
Practice Address - Fax:561-510-7152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Multi-Specialty
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty