Provider Demographics
NPI:1528165040
Name:PHYSICAL THERAPY AND FITNESS INSTITUTE, INC
Entity type:Organization
Organization Name:PHYSICAL THERAPY AND FITNESS INSTITUTE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:CANDELA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:772-287-8511
Mailing Address - Street 1:2020 SE OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3304
Mailing Address - Country:US
Mailing Address - Phone:772-287-8511
Mailing Address - Fax:772-223-0565
Practice Address - Street 1:2020 SE OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3304
Practice Address - Country:US
Practice Address - Phone:772-287-8511
Practice Address - Fax:772-223-0565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106615Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER