Provider Demographics
NPI:1962723601
Name:ANGEL HANDS PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:ANGEL HANDS PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:I
Authorized Official - Last Name:DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:772-834-5167
Mailing Address - Street 1:121 NE TUNISON AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-1732
Mailing Address - Country:US
Mailing Address - Phone:772-834-5167
Mailing Address - Fax:
Practice Address - Street 1:121 NE TUNISON AVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-1732
Practice Address - Country:US
Practice Address - Phone:772-834-5167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20263251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6110Medicare PIN