Provider Demographics
NPI:1902235724
Name:PHYSICAL THERAPY SPECIALISTS OF WILTON MANORS
Entity type:Organization
Organization Name:PHYSICAL THERAPY SPECIALISTS OF WILTON MANORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:RIGANOTTI
Authorized Official - Last Name:R
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:754-206-2031
Mailing Address - Street 1:1881 NE 26TH ST
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1416
Mailing Address - Country:US
Mailing Address - Phone:754-206-2031
Mailing Address - Fax:754-206-2032
Practice Address - Street 1:1881 NE 26TH ST
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1416
Practice Address - Country:US
Practice Address - Phone:754-206-2031
Practice Address - Fax:754-206-2032
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INFECTIOUS DISEASE ADVISORY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-02
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8724332B00000X
273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies