Provider Demographics
NPI:1992935936
Name:FELDMAN, PAUL JAY (PT, OTR)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JAY
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:PT, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 NW 165TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1472
Mailing Address - Country:US
Mailing Address - Phone:954-801-3201
Mailing Address - Fax:954-432-4377
Practice Address - Street 1:755 NW 165TH AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1472
Practice Address - Country:US
Practice Address - Phone:954-801-3201
Practice Address - Fax:954-432-4377
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL3254225100000X
FL0995225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY2079Medicare PIN