Provider Demographics
NPI:1891467981
Name:PHOENIX THERAPY SERVICES FL LLC
Entity type:Organization
Organization Name:PHOENIX THERAPY SERVICES FL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHAZ
Authorized Official - Middle Name:IMAIRI
Authorized Official - Last Name:ABRAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-826-3496
Mailing Address - Street 1:2630 W BROWARD BLVD # 203-1265
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-1314
Mailing Address - Country:US
Mailing Address - Phone:954-826-3496
Mailing Address - Fax:
Practice Address - Street 1:2630 W BROWARD BLVD # 203-1265
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-1314
Practice Address - Country:US
Practice Address - Phone:954-826-3496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy