Provider Demographics
NPI:1427482751
Name:ULTIMATE ANGELS PHYSICAL THERAPY, LLC.
Entity type:Organization
Organization Name:ULTIMATE ANGELS PHYSICAL THERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-594-9070
Mailing Address - Street 1:129 NW 13TH ST
Mailing Address - Street 2:SUITE 30
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-1634
Mailing Address - Country:US
Mailing Address - Phone:954-594-9070
Mailing Address - Fax:877-308-9742
Practice Address - Street 1:129 NW 13TH ST
Practice Address - Street 2:SUITE 30
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1634
Practice Address - Country:US
Practice Address - Phone:954-594-9070
Practice Address - Fax:877-308-9742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4404385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care