Provider Demographics
NPI:1699715599
Name:PHYSICAL THERAPY SPECIALISTS, LLC
Entity type:Organization
Organization Name:PHYSICAL THERAPY SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANOS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:386-447-0610
Mailing Address - Street 1:397 PALM COAST PARKWAY SW
Mailing Address - Street 2:UNIT 4
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4777
Mailing Address - Country:US
Mailing Address - Phone:386-447-0610
Mailing Address - Fax:386-447-0670
Practice Address - Street 1:397 PALM COAST PARKWAY SW
Practice Address - Street 2:UNIT 4
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4777
Practice Address - Country:US
Practice Address - Phone:386-447-0610
Practice Address - Fax:386-447-0670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 222912251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9607Medicare ID - Type UnspecifiedGROUP NUMBER