Provider Demographics
NPI:1699709667
Name:PHYSICAL THERAPY AT YOUR HOME, INC
Entity type:Organization
Organization Name:PHYSICAL THERAPY AT YOUR HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RPT
Authorized Official - Phone:321-437-3550
Mailing Address - Street 1:908 CANNES DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-3815
Mailing Address - Country:US
Mailing Address - Phone:321-437-3550
Mailing Address - Fax:407-935-9811
Practice Address - Street 1:908 CANNES DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3815
Practice Address - Country:US
Practice Address - Phone:321-437-3550
Practice Address - Fax:407-935-9811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17856225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9174Medicare ID - Type UnspecifiedGROUP ID NUMBER