Provider Demographics
NPI:1962572917
Name:PHYSICAL THERAPY AND REHABILITATION ASSOCIATES INC.
Entity type:Organization
Organization Name:PHYSICAL THERAPY AND REHABILITATION ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:954-701-0528
Mailing Address - Street 1:900 RIVER REACH DR APT 110
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-1164
Mailing Address - Country:US
Mailing Address - Phone:954-701-0528
Mailing Address - Fax:
Practice Address - Street 1:900 RIVER REACH DR APT 110
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33315-1164
Practice Address - Country:US
Practice Address - Phone:954-701-0528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty