Provider Demographics
NPI:1699532325
Name:CENTRUM PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:CENTRUM PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:LMT,PTA
Authorized Official - Phone:786-523-3208
Mailing Address - Street 1:7200 NW 7TH ST STE 320
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2955
Mailing Address - Country:US
Mailing Address - Phone:786-523-3208
Mailing Address - Fax:
Practice Address - Street 1:7200 NW 7TH ST STE 320
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2955
Practice Address - Country:US
Practice Address - Phone:786-523-3208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center